Anomalous arrangement of the pancreatobiliary ductal system in patients with a choledochal cyst

Todani, Takuji; Watanabe, Yasuhiro; Fujii, Tadashi; Uemura, Sadashige

doi:10.1016/0002-9610(84)90139-9

Cited by 142 publications

(75 citation statements)

References 6 publications

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“…[4][5][6] Total cyst excision with hepaticoenterostomy is the treatment of choice for choledochal cyst. 2,3 Excision has also the advantage of stopping reflux of pancreatic juice through pancreaticobiliary maljunction, which has so often been associated with choledochal cysts.…”

Section: Discussionmentioning

confidence: 99%

“…In children, there are different levels of biliary amylase, [17][18][19] and postoperative complications are less common than in adults. 5,6,[8][9][10]16,20,21 Yamataka et al 20 studied anastomotic stricture that developed in four patients who underwent operation under 19 years of age, respectively, and found that increase of age had increased incidence because there were no anastomotic strictures in 145 children who underwent operation at 5 years or younger. Furthermore, inflammation of the cyst wall was found to be mild in children under 10 years of age and more severe in older children, indicating that histological damage to the common hepatic duct used for bilioenteric anastomosis is more severe in older children and adults.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Kim

Choi

Han

et al. 2008

Journal of Gastrointestinal Surgery

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The aim of this study was to investigate the risk factors of postoperative anastomotic stricture after excision of choledochal cysts and hepaticojejunostomy. Among 65 patients who underwent surgery for choledochal cyst between March 1995 and June 2005, we selected 34 adult patients who were diagnosed as having choledochal cyst. We divided patients into two groups, depending on postoperative anastomotic stricture developed or not. Medical records and radiological findings of each patient were reviewed retrospectively. H&E stain and Masson-Trichrome stain of each specimen of the resected cyst were performed, and thickness of cyst wall, the grade of fibrosis, loss of smooth muscle layer, loss of mucosa, and infiltration of inflammatory cells were measured. Of the 34 patients, excision of choledochal cyst and hepaticojejunostomy were done in 33 patients, and 1 patient with chronic pancreatitis underwent pylorus-preserving pancreaticoduodenectomy. Anastomotic stricture and intrahepatic duct stones postoperatively developed in eight patients; one patient of 19 type I cyst and seven patients of 15 type IVa, developing significantly more in the type IVa choledochal cyst (P<0.05). The size of choledochal cyst in the stricture group was 7.0 cm, and that of the non-stricture group, 4.2 cm, showing significant difference between the two groups (P<0.05). The stricture group presented shorter duration of symptoms (27.63±61.72 days; ranged, 1∼180 days) than the non-stricture group (483.33±916.41 days; ranged, 1∼3,560 days), and it was statistically significant (P<0.05). Pathologically, significant difference was found between anastomotic stricture and infiltration of inflammatory cells (P<0.05). The results indicate that anastomotic stricture is influenced by the type IVa choledochal cyst, size of cyst, duration of symptoms, and the grade of infiltration of inflammatory cells. Therefore, closed careful follow-up is important in patients who underwent cyst excision with hepaticojejunostomy for type IVa choledochal cyst. If the anastomotic stricture develops, nonoperative management should be recommended, rather than operation, as much as possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Kim

Choi

Han

et al. 2008

Journal of Gastrointestinal Surgery

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“…[1][2][3][7][8][9]19 Em estudos de necrópsia de indivíduos normais, verificou-se que em 85% dos casos, a união do colédoco e do ducto pancreático principal resulta na formação de um canal comum curto no interior da parede duodenal, sujeito ao controle do esfíncter de Oddi existente em torno da papila duodenal maior. Na criança normal, o comprimento máximo do canal comum é de até 4 mm e no adulto 10mm.…”

Section: Discussionunclassified

“…Assim, a incidência de ducto comum longo em pacientes com cisto de colédoco varia de 40 a 100%. [4][5][6][7][8][9] Em publicação recente da escola japonesa, entre 26 pacientes com dilatação da via biliar, 25 apresentavam ducto comum longo (96,2%) 16 . Com base nesses conhecimentos, no caso 9 pôde-se dispensar a investigação radiológica aliado ao fato de que as condições clínicas da criança eram precárias.…”

Section: Discussionunclassified

Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children

Tannuri¹,

Pessoa²,

Sakane³

et al. 1994

J Pediatr (Rio J)

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Pediatria 359 ResumoSão apresentadas nove crianças cujas idades variaram entre 2 meses e 11 anos, com dilatação congênita da via biliar extra-hepática, com ou sem acometimento intrahepático, e oito delas, submetidas à investigação radioló-gica, apresentaram anomalia da junção entre o colédoco e o ducto pancreático principal. Forma-se assim um ducto comum longo, antes da penetração na parede duodenal, o que permite a passagem contínua de suco pancreático, rico em enzimas proteolíticas, para a árvore biliar. Como conseqüência, ocorre lesão da parede dos ductos biliares, substituição da camada muscular por tecido fibroso e dilatação em intensidade e extensão variáveis.O sintoma clínico mais importante foi a dor abdominal, acompanhada ou não de vômitos ou icterícia do tipo obstrutiva. Em apenas uma criança, havia dilatação do colédoco do tipo cística, que se manifestou clinicamente como massa palpável no hipocôndrio direito. Em oito crianças, o diagnóstico de dilatação da via biliar foi feito pela ultrassonografia abdominal e, em um caso, por visualização direta durante laparotomia de emergência. O diagnóstico de ducto comum longo foi confirmado pela colangiopancreatografia endoscópica transpapilar, no pré-operatório, ou pela colangiografia intra-operatória. Em apenas um caso, não foi feita investigação radiológica em virtude das más condições clínicas.O tratamento de eleição, realizado nos nove casos, foi a derivação bílio-digestiva em Y de Roux. O seguimento tardio revelou que todas as crianças estão bem, sem sintomas relacionados com a doença de base.J. pediatr. (Rio J.). 1994; 70(6):359-364: dilatação congê-nita do trato biliar, cisto de colédoco, canal comum colé-doco-pancreático. AbstractNine children aged between 2 months and 11 years, who had congenital dilatation of extrahepatic biliary tract, with or without intrahepatic dilatation, are presented. The radiological studies performed in eight patients demonstrated abnormal choledochopancreatico ductal junction. Thus, a long common channel is formed out of the duodenal wall, leading to a continuous reflux of pancreatic juice into the biliary system, chronic inflammation of biliary tract wall, fibrosis of muscular layer and finally different types of dilatations.The main clinical findings were upper abdominal pain, vomiting, or obstructive jaundice. In only one child the dilatation was cystic type and the clinical manifestation was palpable abdominal mass. In eight patients the initial diagnosis of biliary tract dilatation was made through abdominal ultrasound and in one case by direct visualization through emergent exploratory laparotomy. The final confirmation of the presence of long common channel was made by preoperative endoscopic retrograde cholangiopancreatography or intraoperative cholangiogram. The radiologic investigation was not performed in only one case due to bad clinical conditions. The surgical treatment indicated to all cases was Rouxen-Y hepatic-jejunostomy. The late follow up demonstrated that all patients are well and assymptomatic.J. pedia...

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“…In 1984,Todani and co-workers,in an analysis of retrograde Cholangiopancreatography (ERCP) suggested that the most patients had an anomalous arrangement of the pancreaticobiliary ductal system in which the pancreatic duct entered the common bile duct in a proximal location,well outside the circular muscle of the ampulla of Vater,which would permit reflux of pancreatic enzymes containing trypsin upward into common bile duct during fetal development resulting damage of ductal wall and subsequent dilatation. 7 This 'common channel ' theory related to the etiology of choledochal cyst was originally was suggested by Babbitt in 1969. 8 Ito,Miyano, Spitz and others have suggested that obstruction of the level of duodenum is an additive factor in this Process, which tends to produce saccular dilatation of distal common bile duct.…”

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confidence: 99%

Choledochochal Cyst

Mahbub-ul-Alam

2013

J. paediatr. surg. Bangladesh

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Anomalous arrangement of the pancreatobiliary ductal system in patients with a choledochal cyst

Cited by 142 publications

References 6 publications

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Risk Factors of Postoperative Anastomotic Stricture After Excision of Choledochal Cysts with Hepaticojejunostomy

Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children

Choledochochal Cyst

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