Background Pancreaticobiliary maljunction is a congenital anatomical abnorma l junction of the pancreatic duct and bile duct into a common channel outside the duodenal wall. Pancreas divisum is also a congenital anatomical abnormality characterized by unfused pancreatic ducts. Intestinal malrotation is caused by the failure of bowel rotation and fixation. We reported an optimal surgical intervention for the rare case of pancreaticobiliary maljunction and pancreas divisum accompanied intestinal malrotation. Case presentation A 2-year-old female presented with fever and jaundice. Abdominal ultrasound showed dilated common bile duct and intrahepatic bile ducts; MRCP showed pancreaticobiliary maljunction, pancreas divisum, and dilated biliary system; Abdominal contrast-enhanced CT showed a reversed relationship between the superior mesenteric artery and the superior mesenteric vein. An operation of laparoscopic resection of the extrahepatic bile duct, Roux-en-Y hepaticojejunostomy, and Ladd’s procedure was performed after the inflammation of the biliary system was treated. The post-operative follow-up period was uneventful. Conclusions The management of pancreas divisum can be conservative. We present an optimal pattern of Roux-en-Y hepaticojejunostomy to deal with pancreaticobiliary maljunction associated with intestinal malrotation.
Purpose To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children.Methods A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal extraluminal (n = 24), ileal intraluminal (n = 41), ileocecal valve (n = 11), cecal extraluminal (n = 3), and cecal intraluminal (n = 18) types according to their locations.Results Mean age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P=0.004). Ileocecal resection and ileocolostomy, and cyst excision were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision performed in patients with different types were 91.7% (22/24), 78.0% (32/41), 27.3% (3/11), 100.0% (3/3), and 27.8% (5/18) (P 0.001). Mean time of oral intake and hospital stay after surgery were signi cantly shorter in patients undergoing cyst excision (P=0.003; P 0.001). There were no signi cant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P=0.008).Conclusions Ileocecal duplications at speci c locations are prone to intussusception and can in uence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection. What Is KnownHow to address ileocecal duplication has always been challenging in clinical management.Children who have an ileocecal resection can develop some early postoperative complications.What is New: Ileocecal duplications at speci c locations are prone to intussusception and can in uence the surgical procedure choice.Children's mid-term growth and defecation patterns are not affected by ileocecal resection.
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