Spontaneous Rupture Of Choledochal Cyst Research Articles

Spontaneous Rupture of Choledochal Cyst: A Rare Presentation

AbstractCholedochal cyst (CDC) is a rare surgical cause of cholestatic jaundice in infants. Spontaneous rupture is an unusual presentation of a previously undiagnosed CDC and is also a rare cause of biliary peritonitis in children. Here, we report a case of a 1-year-old boy who was evaluated for progressive abdominal distension. Ultrasonogram showed gross ascites with echogenic particles, dilated common bile duct (CBD), common hepatic duct (CHD), and upstream intra hepatic biliary radicle dilatation (IHBRD). CECT sections of the abdomen showed gross ascites and IHBRD with disproportionate dilatation of CHD and CBD. At laparotomy, a type 1 CDC with rupture of the anterior wall was found. The cyst was excised followed by hepaticojejunostomy. In a sick child with abdominal pain, cholestatic jaundice and biliary ascites, a high index of suspicion during imaging will help in the correct diagnosis and surgery for a potentially fatal ruptured CDC.

EP.TH.714Adult Spontaneous Choledochal Cyst Rupture: A Case Report of a Rare Presentation

Abstract Background Choledochal cysts are uncommon congenital biliary duct dilatation involving either intra-hepatic, extra-hepatic ducts or both. The presentation varies among pediatric age groups compared to adults, in which pediatrics present mostly with jaundice whereas adults present with abdominal pain. It carries high-risk complications and related malignancy depending on the type of cyst. There were few reported cases of spontaneous rupture of choledochal cyst in adults. Case Description A 35-year-old female, medically and surgically free. Presented to Emergency Department with recurrent episodes of non-bilious vomiting for three weeks, managed conservatively. One day later, she presented with generalized abdominal pain with persistent vomiting. The patient mentioned a history of chronic abdominal pain for 6 years. On examination, the abdomen was tender all over with signs of peritonitis. A Computed Tomography scan revealed a septated intra-hepatic duct cyst measuring 9 x 11 cm. Therefore, she was taken to the operating room for exploratory laparoscopy, washout was done and drains were inserted. Afterward, Endoscopic Retrograde Cholangio-Pancreatography with sphincterotomy and stenting performed. Six weeks later, she underwent elective left hepatectomy and histopathology confirmed the choledochal cyst. She had an uneventful postoperative course with two weeks follow up with no complications. Conclusion Ruptured choledochal cyst is a rare presentation and high clinical suspicion is warranted in adult patients who present with a surgical abdomen along with a history of chronic abdominal pain. This case report represents the importance of conservative treatment before the definitive operation, to allow resolution of the peritonitis and lower the consequences.

A Rare Cause of Acute Abdomen in Children: Spontaneous Rupture of Choledochal Cyst Causing Peritonitis

Spontaneous rupture of the common bile duct cyst is a rare cause of acute abdomen in children. In our case, we present a 3-year-old patient with no history of trauma, whose diagnosis was confirmed by laparotomy, with a possible suspected common bile duct cyst due to massive ascites and a cystic lesion in the portal area. Although common bile duct cysts are mostly asymptomatic, various studies have shown that malignant transformation can cause important complications such as pancreatitis.Numerous causes have been suggested in the etiopathogenesis of rupture, such as parietal necrosis associated with pancreatic reflux irritation.Since rupture of cysts may require urgent laparotomy such as biliary peritonitis, it is important to know imaging findings that may be warning for early diagnosis. Because of the increased risk of cholangiocarcinoma after cyst excision, cholecystectomy and Roux-en-Y hepaticojejunostomy are the most common treatment procedures.

Modified method of T-tube placement in cases of ruptured choledochal cyst having complete loss of anterior wall

Survival rates for infants and children who have choledochal cyst with or without spontaneous rupture have improved dramatically in the past decades. Despite excellent long-term survival for patients with choledochal cyst who undergo elective surgery, many significant complications can occur in the patients being operated in emergency for rupture of the cyst. Spontaneous rupture of the cyst is one such problem resulting in considerable morbidity and mortality in these patients. Majority of surgeons manage these cases with T-tube external drainage. The conventional methods of T-tube placement for long period has remained simple as described in choledochotomies where there is no deficit of the walls of common bile duct (CBD). The present technique has been designed specially for the cases of ruptured choledochal cyst, where the wall of the CBD gets necrosed leaving behind a long gap between the two ends. In these cases, placement of T-tube with conventional method is not possible because there is no wall to suture together, and make the CBD water tight again to prevent leakage of bile. We found only two patients of spontaneous rupture of choledochal cyst with a long gap between two ends of CBD because of necrosed anterior wall. In both of these patients, it was not possible to put T-tube with traditional method and one would have to opt for primary definitive repair despite poor general condition of patients.

Spontaneous rupture of choledochal cyst with pseudocyst formation—report on 2 cases and literature review

Spontaneous rupture and subsequent bile peritonitis are rare complications of choledochal cysts. Of these complications, the formation of a biliary pseudocyst is an unusual form, and its preoperative diagnosis is difficult. In this report, we describe 2 cases showing spontaneous rupture with biliary pseudocyst formation. Inflammatory tissue surrounded those pseudocysts, one of which was adjacent to the perforation and the other formed in the transverse mesocolon apart from the biliary tract. These pseudocysts were removed by careful dissection, and single-stage cyst excision with biliary reconstruction was successfully performed in both cases.

Spontaneous Rupture of Choledochal Cyst: Case Report

Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

Bile Peritonitis Due to Spontaneous Rupture of Choledochal Cyst iagnosed by Hepatobiliary Scintigraphy in an Infant

Bile Peritonitis Due to Spontaneous Rupture of Choledochal Cyst iagnosed by Hepatobiliary Scintigraphy in an Infant

Spontaneous rupture of choledochal cyst: An unusual cause of acute abdomen in children

Rupture is one of the rare complications of choledochal cysts. The cause of rupture is unknown in many cases and is considered to be spontaneous. Two patients admitted to the hospital with acute abdominal picture were initially thought to have postoperative abscess and appendicitis. However, the presence of bilelike fluid suggested a bile tract pathology, and evaluation showed ruptured choledochal cysts. Although spontaneous rupture of a choledochal cyst is a rare complication, and can sometimes be the initial manifestation of a choledochal cyst, it should be considered in the presence of bilelike fluid and differentiated from spontaneous perforation of the bile tract. In spontaneous rupture of choledochal cyst, cystectomy, cholecystectomy, and Roux-Y hepaticoportoenterostomy is the treatment of choice.