Magnetic Resonance Cholangiopancreatography Research Articles

Secondary sclerosing cholangitis due to drug-induced liver injury: a retrospective cohort study

Background The main objective of our study was to assess the frequency of drug-induced liver injury (DILI) patients with coexisting secondary sclerosing cholangitis (SSC) within our center and then analyze clinical features of these patients. SSC has received limited attention in the context of DILI. These changes can be observed on magnetic resonance cholangiopancreatography (MRCP). Methods We conducted a single-center retrospective cohort study involving 185 consecutive patients diagnosed with DILI between January 2020 and August 2024. We reviewed MRCP images of 81 available patients. Results Among the 185 patients, 81 underwent MRCP and 14 patients (17.3%) were diagnosed with SSC. Nine (64.3%) of 14 were diagnosed with biliary strictures in extrahepatic bile ducts, and 11 of 14 patients (78.6%) displayed segmental distribution. The SSC group showed higher peak alkaline phosphatase (ALP) values (660 vs. 290 U/l, P = 0.015), longer resolution time (114 vs. 61 days, P = 0.038), and a higher frequency of chronic injury (35.7% vs. 10.4%, P = 0.016). Multivariate logistic regression analysis identified peak ALP values as a risk factor for SSC [odds ratio = 1.002 (1.000–1.005), P = 0.030]. Conclusion The prevalence of drug-related SSC has noticeably increased in recent years. The higher peak ALP values potentially associated with an increased risk of drug-related SSC onset.

Gun-sight technique with dual hepatic vascular embolization for sigmoidal refractory biliary stricture after living-donor liver transplantation: A Case Report

BackgroundBiliary stricture is a common complication after living-donor liver transplantation (LDLT), but its management is challenging. We herein report a case of successful internal drainage achieved through combination of the gun-sight technique and dual hepatic vascular embolization (DHVE). Case presentationA 54-year-old woman with primary biliary cholangitis underwent ABO-incompatible LDLT with the right lobe. Duct-to-duct biliary anastomosis was performed, and V5 and V8 of the graft were reconstructed using a vein graft. However, 5 months after surgery, magnetic resonance cholangiopancreatography revealed stricture of the bile duct anastomosis. Endoscopic stenting could not be attempted because of the sigmoidal bending of the bile duct. Instead, percutaneous transhepatic cholangiographic drainage (PTCD) of the anterior and posterior branches was performed. We attempted to remove the PTCD tube by an endofistulization technique. We performed the gun-sight technique, originally employed for transjugular intrahepatic portosystemic shunt procedures, to create a pathway for internal drainage of the posterior segment. The anterior lobe was abandoned by applying DHVE, resulting in no external drainage tubes. ConclusionApplication of the gun-sight technique with DHVE for sigmoidal refractory biliary stricture after LDLT appears to be a feasible treatment.

Obstructive jaundice caused by an abdominal tuberculous mass lesion.

Tuberculosis is a global epidemic infection that typically presents with symptoms affecting the respiratory system. Abdominal tuberculosis is an uncommon manifestation, occurring in only 5% of tuberculosis cases globally and can present with a broad range of vague symptoms that mimic other biliary and pancreatic pathologies. We report a case of a 36-year-old woman presenting with jaundice and biliary obstruction secondary to abdominal tuberculosis. Computed tomography and magnetic resonance cholangiopancreatography revealed a loculated retroperitoneal mass abutting the pancreatic head and duodenum with associated common bile duct dilatation. Endoscopic ultrasound demonstrated an ulcerated mass in the duodenum which was biopsied. Necrotising granulomas were identified on histology and the biopsied tissue was positive on tuberculosis polymerase chain reaction testing. Thus, extrapulmonary abdominal tuberculosis was diagnosed. The patient was commenced on a 6-month course of rifampicin, isoniazid, pyrazinamide and ethambutol treatment and demonstrated complete response to medical therapy. Abdominal tuberculosis can be difficult to diagnose but should remain an important differential to be considered for patients with previous travel or residence in endemic areas presenting with gastrointestinal symptoms. Prompt diagnosis and treatment can prevent unnecessary procedures, complications and death in patients with biliary obstruction caused by abdominal tuberculosis.

Diagnosis and Treatment of Choledochal Cysts: A Comprehensive Review with a Focus on Choledochocele.

Choledochal cysts (CCs) are cystic dilations of intrahepatic and/or extrahepatic bile ducts. Around 80% of CCs are diagnosed within the first decade of life. These complex clinical entities are extremely rare, especially in the Western population. CCs are frequently classified according to the Todani classification. CCs may be asymptomatic or present as acute pancreatitis and/or cholangitis, biliary obstruction, or malignancy. Therefore, the diagnosis relies primarily on abdominal imaging modalities, mainly magnetic resonance cholangiopancreatography. Management is tailored based on the cyst morphology and the patient's clinical characteristics, with surveillance, surgery, and interventional endoscopy being the most frequent management options. While the surgical approach is the most frequently employed, type III CCs (also known as choledochocele) are frequently managed endoscopically, and novel endoscopic, minimally invasive treatment options are rapidly emerging.

Application of EUS or MRCP prior to ERCP in patients with suspected choledocholithiasis in clinical practice

Background: Patients with symptomatic cholelithiasis can be stratified according to the 2019 European Society for Gastrointestinal Endoscopy (ESGE) guideline into low-, intermediate- and high-likelihood groups for the presence of choledocholithiasis. For the intermediate group, endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) is recommended to assess whether an endoscopic retrograde cholangiopancreatography (ERCP) is necessary prior to cholecystectomy. Objective: The aim of the study is to investigate adherence to the guideline for diagnostic and treatment strategy for cholelithiasis in daily clinical practice. Patients and methods: Multicenter, retrospective cross-sectional observational study of the diagnostic pathway of patients with suspicion of choledocholithiasis between 2019 and 2021. Patients were stratified according to the ESGE guideline "Endoscopic management of common bile duct stones”. Results: A total of 305 patients were included in the analysis and stratified into low- (17%), intermediate- (40%) and high- (43%) likelihood of choledocholithiasis. In these three categories, 182 (60%) patients underwent ERCP. Adherence to the ESGE guideline recommendation was 59.7% overall and was the highest in the intermediate-likelihood group (83.6%), compared to 45.1% in the low- and 43.2% in the high-likelihood group, respectively (p <.001). In the high-likelihood group, 49% underwent additional imaging. In 195 patients who underwent additional imaging, 55 ERCPs (28.2%) could be avoided. Conclusion: This study shows that stratification according to the ESGE guideline is useful to reduce the number of unnecessary additional imaging procedures and ERCPs in patients with a suspicion of choledocholithiasis. It seems worthwhile to perform EUS prior to the ERCP in the same session.

REVISÃO DE LITERATURA: MANEJO DO PACIENTE COM COLANGITE ESCLEROSANTE PRIMÁRIA

The primary sclerosing cholangitis (PSC) is a progressive, idiopathic, immune mediated disease, characterized by intra or extrahepatic cholestasis, Inflammation and fibrosis of the bile ducts, which may progress to liver cirrhosis or cholangiocarcinoma (CCA) in the vast majority of patients. Objective: Analyze what the current literature discusses about the management of PSC. Method: A systematic review was carried out using the PubMed and SciELO database, applying the descriptors "Primary Sclerosing Cholangitis" AND "Cholangite" AND "Clinical management" AND Cholangiocarcmoma. Discussion: It is more common in men, with an average diagnosis at 35 years old. The PSC has a wide range of symptoms and stages of the disease. In the beginning, symptoms are rare and patients may be asymptomatic. The most commonly found symptoms are pruritus, fatigue, right upper quadrant abdominal pain, jaundice, fever, and weight loss. In about 75% of patients with PSC, liver function tests are chronically abnormal and fluctuating with a most commonly found pattern of cholestatic condition with elevation of alkaline phosphatase (AF) and yglutamyl transferase (GGT). Although endoscopic retrograde cholangiopancreatography (ERCP) is conventionally considered the gold standard test for the diagnosis of PSC, the main modality of choice currently for Imaging diagnosis in patients with suspected PSC is magnetic resonance cholangiopancreatography (CPRM). Due to the absence of effective medical therapy for PSC, liver transplantation (LT) remains the only curative option. There is little evidence for the use of medications as a way to inhibit the progression of the disease. Still several new drugs are under investigation, representing the potential to improve survival and clinical outcomes in PSC. Final considerations: We conclude that it is extremely important to approach the management of PSC. The diagnosis is a great challenge since its clinical, laboratory and imaging aspects overlap, as it was portrayed during this exposure. Nevertheless, due to the various differential diagnoses ofjaundice with cholestatic pattern, the etiological search is crucial and the absence of effective medical therapy, with several new drugs under analysis, should guide further studies to improve the survival and clinical outcomes of these patients. Another point to be considered is that there is a scarcity of data in the literature that address the PSC in the Brazilian population.

Deep Learning Reconstruction for Enhanced Resolution and Image Quality in Breath-Hold MRCP: A Preliminary Study

Objective This preliminary study aims to assess the image quality of enhanced-resolution deep learning reconstruction (ER-DLR) in magnetic resonance cholangiopancreatography (MRCP) and compare it with non-ER-DLR MRCP images. Methods Our retrospective study incorporated 34 patients diagnosed with biliary and pancreatic disorders. We obtained MRCP images using a single breath-hold MRCP on a 3T MRI system. We reconstructed MRCP images with ER-DLR (matrix = 768 × 960) and without ER-DLR (matrix = 256 × 320). Quantitative evaluation involved measuring the signal-to-noise ratio (SNR), contrast, contrast-to-noise ratio (CNR) between the common bile duct and periductal tissues, and slope. Two radiologists independently scored image noise, contrast, artifacts, sharpness, and overall image quality for the 2 image types using a 4-point scale. Results are expressed as median and interquartile range (IQR), and we compared quantitative and qualitative scores employing the Wilcoxon test. Results In quantitative analyses, ER-DLR significantly improved SNR (21.08 [IQR: 14.85, 31.5] vs 15.07 [IQR: 9.57, 25.23], P < 0.001), CNR (19.29 [IQR: 13.87, 24.98] vs 11.23 [IQR: 8.98, 15.74], P < 0.001), contrast (0.96 [IQR: 0.94, 0.97] vs 0.9 [IQR: 0.87, 0.92], P < 0.001), and slope of MRCP (0.62 [IQR: 0.56, 0.66] vs 0.49 [IQR: 0.45, 0.53], P < 0.001). The qualitative evaluation demonstrated significant improvements in the perceived noise (P < 0.001), contrast (P = 0.013), sharpness (P < 0.001), and overall image quality (P < 0.001). Conclusions ER-DLR markedly increased the resolution, SNR, and CNR of breath-hold-MRCP compared to cases without ER-DLR.

HPB SO35 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter

Abstract Background Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach (LCBDE-t) in a district general hospital over a thirty-month period. Method Prospectively collected data regarding all patients who underwent LC+LCBDE-t over a period from January 2022 to June 2024 was retrospectively reviewed. Data including indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel. Results 76 patients were identified. CBD diameter (almost all as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.32). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-32 days) and readmission rate was 5.33%. Five patients experienced a complication beyond Clavien-Dindo Grade II, with the most serious two being a bile leak and a postoperative bleed, both of which required further surgery. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for retained CBD stones. Conclusion LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small CBD diameter. Small CBD should not necessarily be a deterrent to consideration of transcystic LCBDE as a therapeutic option in appropriately selected patients.

Rare carcinoma of the ampulla of Vater with mixed histologies: A case report

The current case is about a 62-year-old female presented with persistent fever for 10 days and yellowing of the skin for 5 days at our outpatient clinic. Laboratory tests revealed elevated levels of total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase. Abdominal computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography revealed a mass in the ampulla of Vater, as well as dilatation of the intra- and extra-hepatic bile and pancreatic ducts. The patient underwent pancreaticoduodenectomy under general anesthesia. Post-operative pathological and immunohistochemical results confirmed a tumor located in the ampulla, measuring 1.5 × 1 × 1 cm. The main component of the tumor was a moderately differentiated pancreaticobiliary adenocarcinoma (ADC), combined with squamous cell carcinoma (SCC) as well as small cell neuroendocrine carcinoma (SCNEC). The cancer tissue infiltrated the entire intestinal wall, with no invasion of microvessels, lymphatic vessels, or nerves observed. Until 46 months later, there was no tumor recurrence or distant metastasis. We present an uncommon case of ADC of the ampulla of Vater combined with SCC and SCNEC. Carcinoma of the ampulla of Vater may have mixed histological components; therefore, in cases of ampullary carcinoma, appropriate specimen collection is necessary, and further studies with more focus on histological origins are required.

Surgical aspects of treatment a patient with choledocholithiasis after gastropancreatoduodenectomy resection

Cholelithiasis is a common problem in surgery. The pathological basis of the disease is a imbalance between cholesterol, bilirubin and bile acid metabolism. There are several risk factors for cholelithiasis, both modifiable and non-modifiable. Complications of this pathology most often require surgical intervention: either planned or emergency. One of such complications is choledocholithiasis. Most often, choledocholithiasis occurs as a result of migration of stones from the gallbladder, less often of stones form in the bile ducts. In the world and Russian literature, many works are devoted to the etiology, pathogenesis and the treatment of patients with choledocholithiasis. The diagnosis is confirmed using advanced imaging methods, such as magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. A widely used method of treatment is endoscopic retrograde cholangiopancreatography in combination with endoscopic papillosphincterotomy. However, in case of severe choledocholithiasis, including with an altered anatomical picture, standard methods do not always allow to achieve the desired result. This article describes a clinical case of successful treatment of a patient with choledocholithiasis that developed two years after gastropancreatoduodenal resection for adenocarcinoma of the major duodenal papilla.

From pancreas to pleura: Unraveling a rare complication

Pancreaticopleural fistulas (PPFs) are a rare and challenging condition in both clinical and diagnostic aspects. It is a rare complication of pancreatitis resulting from pancreatic collections communicating with the pleural cavity. They primarily cause respiratory system symptoms and pleural effusion. We present a case of a 30-year-old male with alcohol-induced pancreatitis presented with 2 months history of shortness of breath and cough. Chest radiograph demonstrated right massive pleural effusion. Repeated thoracentesis showed recurrent hemorrhagic pleural fluid with increased amylase and lipase. Computed tomography revealed no significant cause, and magnetic resonance cholangiopancreatography showed a fistulous tract between the pancreas and the right pleural cavity. The patient’s clinical presentation was misleading due to respiratory complaints, and a high clinical suspicion of PPF in recurrent massive hemorrhagic pleural effusion will lead to this diagnosis.

Utility of under-sampled scans with iterative reconstruction and high-frequency preserving transform for high spatial resolution magnetic resonance cholangiopancreatography.

Under-sampled scans with iterative reconstruction and high-frequency preserving transform (Us-IRHF) can increase the acquisition speed without degrading the image quality by recovering image information from under-sampled data. We investigate the clinical applicability of high spatial resolution magnetic resonance cholangiopancreatography (MRCP) images without extending the scanning time using Us-IRHF. A slit phantom was scanned with conventional- (without Us-IRHF), Us-IR- (without HF), and Us-IRHF scanning. The matrix size was 320 × 320 for Us-IR- and Us-IRHF- and 288 × 208 for conventional scanning. Modulation transfer function (MTF) focused on the 1.0 lp/cm gauge for each scanning was calculated. For clinical study we acquired respiratory-triggered 3D MRCP scans with and without Us-IRHF (U+-, U-MRCP) in 41 patients. The matrix size was 320 × 320 for U+- and 288 × 208 for U-MRCP. The acquisition time and the relative duct-to-periductal contrast ratios (RCs) for the right- and left intrahepatic bile-, the common bile-, and the main pancreatic duct were recorded. Visualization of each duct and overall image quality was scored on 5-point confidence scales. For visualization of each duct the score ranged from 1 (not visible) to 5 (visible with excellent details), for the image quality, it ranged from 1 (undiagnostic) to 5 (excellent). Superiority for the qualitative visualization score and non-inferiority for the RC values with prespecified margins were assessed. Phantom study showed that compared to the conventional- and Us-IR (without HF) images, the MTF for the Us-IRHF image revealed the highest response. For clinical study, the mean acquisition time was 161s for U+- and 165s for U-MRCP. For all ducts, the RC value of U+MRCP was non-inferior to U-MRCP and the qualitative visualization score assigned to U+MRCP was superior to U-MRCP. Us-IRHF improved the image quality of high spatial resolution MRCP without extending the scanning time.

A rare case of retroperitoneal recurrence as squamous cell carcinoma 10 years after nephroureterectomy

IntroductionLocal recurrence for upper tract urothelial carcinoma typically occurs within 2 years post‐surgery. We report a rare case of retroperitoneal recurrence as squamous cell carcinoma 10 years after nephroureterectomy.Case presentationA 67‐year‐old female was referred to our urology department for a left ureteral tumor. The surgical specimen of the laparoscopic left nephroureterectomy revealed urothelial carcinoma at the pT3 stage. Ten years post‐nephroureterectomy, magnetic resonance cholangiopancreatography revealed a mass lesion in the left retroperitoneum, a computed tomography‐guided biopsy revealed squamous cell carcinoma. Despite suspected distant metastases of other organ tumors, examinations such as digestive endoscopy and bronchoscopy did not reveal any tumor lesions. The patient was diagnosed with recurrent invasive urothelial carcinoma as a pathological feature of squamous cell carcinoma.ConclusionThe decision‐making process for treating malignant tumors, such as in cases with recurrence as squamous cell carcinoma, can be challenging.

Primary division of annular pancreas: a surgical technique.

The authors presented a case of duodenal obstruction in a 61-year-old man, resulting from an annular pancreas diagnosed on imaging (computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound). The patient underwent a diagnostic laparoscopy. Intraoperatively, given a straightforward appearance and anatomy of the annular pancreas overlying the second part of the duodenum, and due to extensive adhesions in the abdomen, a primary division of the annular pancreas was performed, instead of a bypass procedure such as gastrojejunostomy. He had some residual symptoms 1 week postoperatively which was treated with duodenal dilatation endoscopically. On review and follow-up at 1 year, he has remained well with resolution of symptoms, supported by radiological improvement on a computed tomography performed at 4months post-operatively. We believe this approach has resulted in less morbidity and a shorter period of recovery as compared to a bypass procedure and represents a reasonable therapeutic option for annular pancreas.

Imaging of Ischemic Cholangiopathy Following Donation after Circulatory Death Liver Transplant.

Ischemic cholangiopathy (IC) is the leading cause of inferior long-term outcomes following donation after circulatory death (DCD) liver transplant. Biliary strictures related to IC are nonanastomotic strictures (NASs) by definition and involve the donor hepatic ducts proximal to the anastomosis, compared with postsurgical anastomotic strictures that form due to fibrotic healing. IC-related NASs can be microangiopathic with patent hepatic artery or macroangiopathic with occluded or stenotic hepatic artery. Recently, IC with NASs have been described to have four distinct patterns at imaging: diffuse necrosis, multifocal progressive, confluence dominant, and minor form, which correlate clinically with graft prognosis. Severe IC can lead to ductal wall breakdown with subsequent bile leaks that can cause significant patient morbidity, with imaging playing a vital role in diagnosis and guiding intervention. IC also predisposes the transplanted liver to biliary stasis and subsequent formation of stones, casts, and sludge. Some cases of posttransplant biliary stricturing are not IC but are a sequela of reflux cholangitis seen with choledochojejunal anastomosis. Other biliary findings in the posttransplant liver can be explained by sphincter of Oddi dysfunction that results from denervation. The authors describe and comprehensively categorize the various IC types and their imaging patterns at MRI and MR cholangiopancreatography, review the prognostic significance of these imaging patterns, and discuss imaging features of additional biliary complications associated with IC after DCD liver transplant. ©RSNA, 2024 Supplemental material is available for this article.

Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Diagnosis

The diagnosis of common bile duct (CBD) stones is conducted through various imaging tests, endoscopic examinations, and the patient's clinical presentation. In patients with symptomatic gallstone disease, initial tests such as liver function tests, abdominal ultrasound, and abdominal computed tomography can be performed. Based on the results of these initial tests, symptomatic patient with cholelithiasis can be classified into low risk, intermediate risk, and high risk groups. Low risk of choledocholithiasis is characterized by normal liver function test results and absence of CBD dilation on abdominal ultrasound. For patients in this category, additional tests are not necessary unless symptoms indicating CBD stones persist. Intermediate risk of choledocholithiasis is identified by abnormal liver function test results or CBD dilation on abdominal ultrasound. Additional tests such as endoscopic ultrasound or magnetic resonance cholangiopancreatography can be performed. If CBD stones are confirmed in the additional tests, endoscopic retrograde cholangiopancreatography (ERCP) is required. High risk of choledocholithiasis is diagnosed when there is clinical evidence of cholangitis or CBD stones are identified on imaging tests. In such cases, ERCP is recommended for both diagnosis and treatment purposes without the need for further additional tests.

Minilaparotomy choledocholithotomy in patients with metabolic syndrome

Aim. To evaluate the outcomes of mini-laparotomy choledocholithotomy in patients with choledocholithiasis and metabolic syndrome using “Mini-Assistant” instruments.Materials and Methods. This study is based on the outcomes of surgical interventions performed on 54 patients diagnosed with choledocholithiasis accompanied by metabolic syndrome, conducted between 2009 and 2022. A minimally invasive laparoscopic approach was utilized, employing “Mini-Assistant” instruments. Preoperative assessments included laboratory tests, ultrasound examination, electrocardiography, echocardiography, respiratory function testing, chest radiography, esophagogastroduodenoscopy, and magnetic resonance cholangiopancreatography (MRCP). The miniaccess operation was performed using a transrectal incision, 6-7 cm in length. The technical steps of the operation were similar to traditional cholecystectomy and choledocholithotomy.Results. The average duration of the procedure was 68 ± 9.3 minutes. The patients’ condition before and after surgery was satisfactory, with stable hemodynamics. No hypertensive crises or tachycardia were observed. No mortality was reported. Postoperative complications were observed in three patients, including accumulation of serous fluid in the subcutaneous tissue (2 cases) and postoperative pancreatitis (1 case). The average length of hospital stay after choledocholithotomy via mini-access was 6 ± 1.6 days.Conclusion. Mini-laparotomy choledocholithotomy using the “Mini-Assistant” instrument set allows for avoiding conventional, more invasive techniques, facilitating effective surgical intervention even in cases where laparoscopic procedures are not feasible.

The mystery of the hidden gallbladder: Navigating the unseen

Key Clinical MessageThis case underscores the importance of advanced imaging techniques in diagnosing complex biliary anomalies. Accurate Magnetic Resonance Cholangiopancreatography and ultrasound evaluations can distinguish between choledochal cysts and duplicate gallbladders, guiding effective surgical intervention and improving patient outcomes.

Hydatid cyst in the tail of the pancreas: a rare case report

Hydatid cysts, caused by Echinococcus granulosus, are rare but significant when found in the pancreas, particularly in endemic regions. This case report discusses a 32-year-old female with a pancreatic tail cyst presenting with epigastric pain and intermittent fever. Diagnostic imaging, contrast enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP), and serological tests were inconclusive, making preoperative diagnosis challenging. Differential diagnoses included pancreatic pseudocysts, benign neoplasms, abscesses, and other cystic lesions. The patient underwent surgical exploration, where a hydatid cyst was identified and treated with cyst removal, partial pericystectomy, and marsupialization. Postoperative management included albendazole therapy. Pancreatic hydatid cysts, though rare, should be considered in differential diagnoses for pancreatic cystic lesions, especially in endemic areas. Accurate diagnosis typically requires a combination of imaging, serology, and histopathological examination, with surgery often necessary for definitive diagnosis and treatment.

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.