1/34. Primary sclerosing cholangitis mimicking choledocal cyst type 1 in a young patient.A choledochal cyst type I was diagnosed in a 12-year-old boy in 1984. The diagnosis was made using ultrasound and confirmed using computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP). Instead of the usual surgical treatment, endoscopic balloon dilatation of the sphincter of oddi and the distal common bile duct was carried out using an endoscopic procedure. The patient experienced relief of symptoms, gained weight and felt healthy again. An ERCP performed in 1990, because of increasing levels of liver enzymes and clinical features of abdominal pain and fatigue, revealed typical cholangiographic findings associated with primary sclerosing cholangitis, including bile duct irregularities with diffuse narrowing and twisting of the bile ducts with localized ectatic and strictured areas. Percutaneous needle liver biopsy confirmed the diagnosis. We conclude that primary sclerosing cholangitis should be considered when interpreting ERCP films from patients who are supposed to have choledochal cysts type I.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/34. A rare malformation of the pancreaticobiliary junction long common channel choledochal cyst and pancreas divisum in a patient with pancreatic cancer.Congenital variants of the pancreaticobiliary junction are rare anomalies that are usually diagnosed in childhood because of recurrent abdominal pain and jaundice. These lesions are associated with several pancreaticobiliary diseases including pancreatitis and malignancy. We observed a rare anomaly of the pancreaticobiliary tract with a combination of several ductal malformations, i.e., choledochal cyst, long common channel and incomplete pancreas divisum in a patient with pancreatic cancer.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
3/34. Hepaticojejunostomy after excision of choledochal cyst in two children with previous biliary surgery.Hepaticojejunostomy Roux-en-Y after excision of choledochal cyst is the treatment of choice for children with choledochal cyst, to prevent the risk of postoperative cholangitis, stone formation and malignancy. The author reports two children with previous biliary surgery for choledochal cyst, one with cystojejunostomy without cholecystectomy and the other with cholecystectomy alone. Two children were admitted to the Pediatric Surgical Unit, Ratchaburi Hospital, with the complaint of chronic abdominal pain. After investigation the two children had cyst excision and hepaticojejunostomy Roux-en-Y. After six and one year follow-up the patients remain asymptomatic. The aim of this report was to show the complication of two previous biliary surgeries for choledochal cyst and support total cyst excision combined with hepaticojejunostomy Roux-en-Y being the treatment of choice for choledochal cyst.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
4/34. Choledochocele demonstrated by computed tomographic cholangiography: report of a case.Choledochocele is a rare cystic congenital malformation of the distal common bile duct, the precise pathogenesis of which remains unclear. It is usually diagnosed in adulthood after many examinations for unclear digestive symptoms, as in the patient whose case is described herein. Of all the diagnostic techniques available, endoscopic retrograde cholangiography (ERCP) seems to be the best; however, it is an invasive procedure associated with some morbidity. Spiral computed tomographic cholangiography with three-dimensional reconstruction is also an interesting screening technique. Malignant transformation of a choledochocele occurs very rarely, compared with other cystic malformations of the biliary tract. If a choledochocele is small and symptomatic, the lesion can be treated by endoscopic sphincterotomy, but larger cysts are more effectively removed by a surgical cystoduodenostomy. We present herein the case of a 25-year-old woman admitted to our hospital in March 1998 with upper right quadrant abdominal pain caused by a choledochocele, who was successfully treated by a cystoduodenostomy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
5/34. Spontaneous rupture of choledochal cyst.choledochal cyst in an uncommon congenital anomaly with classic presentation triad of abdominal pain, jaundice and right upper abdominal mass. Presentation due to biliary peritonitis following cyst rupture is extremely rare. One such case which was successfully treated is being reported.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
6/34. Management of accessory hepatic ducts in choledochal cysts.This report describes the surgical management of 2 children with fusiform choledochal cysts who had accessory hepatic ducts (AHD) identified during excisional surgery for fusiform choledochal cysts (CC). Two children presenting with a triad of recurrent jaundice, fever, and abdominal pain were investigated and found to have type 1 choledochal cyst. Preoperative imaging and intraoperative cholangiography missed the AHD in both cases. In one of the patients, the main and the accessory ducts were separated by the right hepatic artery. In both the patients the accessory ducts were reconstructed successfully into a Roux loop along with the main common hepatic duct. follow-up studies showed no evidence of biliary tract obstruction or atrophic changes in the liver. There was satisfactory uptake and drainage on hepatic scintigraphy. During excision of CC, AHD may be encountered. These may be missed on preoperative imaging. AHD may have a close relationship with neighboring vascular structures in the porta. Accessory hepatic ducts should be anticipated, identified, and reimplanted into the Roux loop during excisional surgery.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
7/34. Choledochal cysts diagnosed in pregnancy: a case report and review of treatment options.An 18-year-old woman at 18 weeks' gestation presented with abdominal pain and jaundice. After extensive evaluation, she was diagnosed as having a choledochal cyst. Ten days after percutaneous drainage, she underwent complete excision and Roux-en-Y hepaticojejunostomy anastomosis. At term, she delivered vaginally without complications. Although choledochal cysts are rare in pregnancy, it is important for the obstetrician to be familiar with the presentation and the best treatment modalities available. Delay in diagnosis and inappropriate treatment can result in maternal morbidity and fetal mortality.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
8/34. Magnetic resonance cholangiopancreatography diagnosed pancreatitis associated choledochal cyst: report of one case.This report describes a 6-year-old girl with a choledochal cyst associated with recurrent pancreatitis. A cystic dilatation of the common bile duct was detected by abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP). She displayed only one of the classic triads: abdominal pain plus pancreatitis. Cyst excision and Roux-en-Y hepaticojejunostomy was indicated in this case. MRCP can be considered as a unique non-invasive tool and the first choice in evaluation of choledochal cyst in pediatric group.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
9/34. choledochal cyst and duodenal atresia: a rare combination.A rare case of congenital duodenal atresia (DA) associated with a choledochal cyst (CC) is reported.At 38 weeks of gestation, a 1,610-g girl was born by cesarean section with a prenatal diagnosis of DA. After the disorder was confirmed by X-ray, she underwent a duodenoduodenostomy for a complete separation of the duodenum with an annular pancreas. Thirty-two months after the initial operation, she developed upper abdominal pain and acholic stools. Abdominal ultrasonography demonstrated a CC and dilatated intrahepatic bile ducts. Magnetic resonance cholangiopancreatography showed an anomalous arrangement of the choledochus and main pancreatic duct. A diffusely dilatated extrahepatic bile duct was resected, and a hepaticoduodenostomy was performed after cholecystectomy. The patient was discharged without complications. We could not find a similar case report in the English literature. Although it is not reported that there is a close relationship in embryologic development of DA and CC, one should be aware of the possibility of this combination.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
10/34. Needle-knife sphincterotomy.Choledochocele, now classified as choledochal cyst type III, is a rare anomaly of the terminal biliary tree causing abdominal pain, pancreatitis, and obstructive cholestasis. Traditionally, the therapy for this malformation has been surgery. Recently, endoscopic therapy has been used alternatively for the treatment of choledochocele mainly in adults. We report two patients with recurrent episodes of acute pancreatitis found to be caused by a large choledochocele; both patients were treated by needle-knife sphincterotomy without complications. They remained asymptomatic at 1 and 2 years' follow-up, respectively. Despite the fact that the risk of bleeding seems to be higher using needle-knife sphincterotomy, when the Choledochocele is large, our experience suggests that needle-knife sphincterotomy can be performed accurately and safely. Further studies are necessary to confirm the safety and effectiveness of needle-knife sphincterotomy in large choledochocles.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
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