Choledochal Cyst and Chronic Pancreatitis — Treated by Proximal Pancreatectomy

Jalleh, R. P.; Williamson, R. C. N.

doi:10.1155/1991/38109

Cited by 13 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was further supported by Jeong et al [5], with a retrospective study showing increased incidence of pancreatitis in those patients with a wide diameter of the proximal pancreatic duct, or the presence of a filling defect, duct anomaly, long ([21 mm) or wide ([5 mm) common channel. Other studies further support the theory [6][7][8]. However, pancreatitis has been demonstrated in remnant dilated choledochal cysts following excision [19].…”

Section: Discussionmentioning

confidence: 68%

See 1 more Smart Citation

Squamous Cell Carcinoma Arising Within a Choledochal Cyst

2008

View full text Add to dashboard Cite

Choledochal cysts are rare congenital or acquired cystic dilatations of the intra- or extrahepatic bile ducts. Their exact pathophysiology remains unclear. Extensive complications exist with untreated cysts, including biliary stasis and inflammation, with resultant stricture and stone formation, cholangitis, pancreatitis, and malignant degeneration. Most commonly reported malignancies include cholangiocarcinoma, adenocarcinoma, and gallbladder cancer. We report the case of a 41-year-old female with a history of chronic calcific pancreatitis, choledocholithiasis, and a large type I choledochal cyst, who presented with flu-like symptoms followed by painless jaundice and weight loss. Endoscopic retrograde cholangiopancreatography and direct cholangioscopy revealed a mass at the biliary bifurcation, a 4-cm choledochal cyst with multiple calculi, absence of anomalous pancreaticobiliary ductal union, and multiple calcifications in the pancreatic head. Pathology demonstrated a synchronous choledochal cyst and squamous cell carcinoma, an infrequently reported phenomenon. We report the associated rare finding of chronic calcific pancreatitis, without anomaly of the pancreatic biliary junction. This suggests that the formation of calculi within the choledochal cyst may contribute to chronic calcific pancreatitis, possibly by virtue of papillary stenosis.

show abstract

Section: Discussionmentioning

confidence: 68%

“…Another complication includes chronic pancreatitis. Although rare, it is often associated with anomaly of the pancreaticobiliary junction [4][5][6][7][8]. Most concerning is malignant transformation, an age-related phenomenon that occurs in 10-14% of adults with CDCs [9,10].…”

Section: Introductionmentioning

confidence: 99%

Squamous Cell Carcinoma Arising Within a Choledochal Cyst

2008

View full text Add to dashboard Cite

show abstract

“…In patients with associated symptomatic chronic pancreatitis, treatment options include: cyst excision combined with a lateral pancreaticojejunostomy if the pancreatic duct is adequately dilated or pancreaticoduodenectomy for predominantly pancreatic head pathology [24,25,26,27,28]. …”

Section: Discussionmentioning

confidence: 99%

Management of Complicated Choledochal Cysts

Lal¹,

Agarwal²,

Shivhare³

et al. 2007

Dig Surg

View full text Add to dashboard Cite

Objectives: The presentation of choledochal cysts (CDCs) is altered by complications such as acute severe cholangitis, hepatolithiasis, spontaneous perforation, portal hypertension, pancreatitis, malignancy of the biliary tract and previous surgery in the form of internal drainage of the cyst. The management and the outcome of such complicated cysts differ from that of an uncomplicated CDC. This presentation is an analysis of our experience with complicated CDCs. Patients and Methods: One hundred and forty-four patients with CDCs were managed at a tertiary level referral hospital in North India, between January 1989 and June 2004. Thirty-three (23%) CDCs were associated with complicating factors: severe cholangitis requiring a biliary drainage procedure prior to definitive operative procedure (n = 11), spontaneous perforation (n = 3), hepatolithiasis (n = 6), acute cholecystitis (n = 1), recurrent acute pancreatitis (n = 1), chronic pancreatitis (n = 1), gastric outlet obstruction (n = 1), portal hypertension (n = 6), biliary tract malignancy (n = 4) and previous internal drainage of the cyst (n = 5). Five patients had more than one complication. The management outcome of complicated CDCs was compared with that of uncomplicated CDCs. Results: Complicated CDCs were significantly more common with type IV-A anatomy. Endoscopic, percutaneous or external surgical biliary drainage procedure was performed in 14 complicated CDCs prior to cyst excision. Desired definitive surgical procedure could be performed in 26/33 (79%) patients with complicated CDCs as compared to 107/111 (96%) patients with uncomplicated CDCs. Four (12%) patients with complicated CDCs had early postoperative complications as compared to 9/111 (8%) patients with uncomplicated CDCs. During a median follow-up of 13 months (2 months to 8 years), 2 patients with complicated CDCs died due to advanced secondary biliary cirrhosis and advanced gall bladder cancer, respectively. Six patients reported complications. Of the 6 patients, 3 required reoperation for a strictured hepaticojejunostomy (n = 2) and hepatolithiasis (n = 1). In contrast, there was no disease-related mortality and only 1 out of 111 patients with uncomplicated cysts had a complication during follow-up. Conclusion: Complicated CDCs merit a carefully planned management strategy including percutaneous, endoscopic and surgical procedures. The management may have to be staged. The outcome depends on the nature of complication and the management strategy adopted.

show abstract

“…Pancreas head resection should be considered as a treatment for residual cysts and stones only in cases where the removal of the residual cysts and stones is impossible even by the aforementioned methods and the symptoms are severe [142].…”

Section: Commentsmentioning

confidence: 99%

Japanese clinical practice guidelines for pancreaticobiliary maljunction

et al. 2012

View full text Add to dashboard Cite

There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.

show abstract

Choledochal Cyst and Chronic Pancreatitis — Treated by Proximal Pancreatectomy

Cited by 13 publications

References 0 publications

Squamous Cell Carcinoma Arising Within a Choledochal Cyst

Squamous Cell Carcinoma Arising Within a Choledochal Cyst

Management of Complicated Choledochal Cysts

Japanese clinical practice guidelines for pancreaticobiliary maljunction

Contact Info

Product

Resources

About