Choledochal cyst associated with an accessory hepatic duct identified by intra-operative endoscopy: case report and literature review

Takahashi, Toshiaki; Shimotakahara, Akihiro; Takahashi, Tsubasa; Lee, Kyeong Deok; Lane, Geoffrey J.; Okazaki, Tadaharu; Yamataka, Atsuyuki

doi:10.1007/s00383-008-2213-x

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…Choledochal cyst association with aberrant hepatic duct (AHD) is rarely reported [1,2]. A 14-year-old female presented with the complaint of recurrent abdominal pain since 6 months.…”

Section: Case Summarymentioning

confidence: 99%

“…On literature review, only nine cases of the right posterior sectoral duct opening into the choledochal cyst are reported [1][2][3][4][5][6][7][8]. AHD is not easily detected on cholangiography as it may be displaced by the choledochal cyst or may be overshadowed by the denser image of the choledochal cyst …”

Section: Case Summarymentioning

confidence: 99%

“…AHD is not easily detected on cholangiography as it may be displaced by the choledochal cyst or may be overshadowed by the denser image of the choledochal cyst [2,6]. In earlier case reports, AHD was diagnosed during or after cyst excision, on repeated ERCP, intra-operative cholangiography, intra-operative endoscopy or on 3D MRCP [2,[6][7][8]. Ligation or missed AHD during surgery may lead to complications like cholangitis, liver abscess, liver atrophy, cirrhosis, biliary fistula or biliary peritonitis.…”

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confidence: 99%

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Choledochal Cyst with Aberrant Right Posterior Sectoral Duct

Singh

Goyal

et al. 2013

Indian J Surg

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Choledochal cysts are focal or diffuse dilatations of the biliary tree. Its association with the aberrant hepatic duct is rarely reported. We present the case of a 14-year-old girl having aberrant right posterior sectoral duct with choledochal cyst. It can be missed on cholangiography and during surgery, leading to serious complications. In this case, it was diagnosed on magnetic resonance cholangiopancreatography and was managed along with cyst excision.Keywords Choledochal cysts . Aberrant hepatic duct . Biliary anomalies . Magnetic resonance cholangiopancreatography Case SummaryCholedochal cyst association with aberrant hepatic duct (AHD) is rarely reported [1,2]. A 14-year-old female presented with the complaint of recurrent abdominal pain since 6 months. On magnetic resonance cholangiopancreatography (MRCP), there was diffuse fusiform dilatation (3 cm) of the proximal and mid common bile duct with involvement of the confluence of the left hepatic duct and right anterior sectoral duct. The right posterior sectoral duct (AHD) was dilated (1.2 cm) and was opened separately into the choledochal cyst. The cystic duct was of normal calibre and had low insertion (Fig. 1). At surgery, AHD was opening about 3 cm away from confluence of the right anterior sectoral duct and left hepatic duct and was extending superiorly in the cyst wall. The cyst was transected just at the confluence of the left hepatic and right anterior duct junction. The adjacent walls of the right posterior sectoral duct and common hepatic duct were sutured and then anastomosed as a single large stoma with Roux-en-Y loop. On follow-up of 1 year, there was no history of pain in the abdomen or cholangitis. Repeat liver function tests and ultrasound were within normal limits.The biliary and anatomical anomalies reported on the choledochal cyst in the literature are primary ductal stricture which may be hilar, confluent or umbilical; aberrant hepatic duct; low confluence of hepatic ducts; aberrant hepatic artery; and very small hepatic duct [3,4]. These have tremendous implications as they are seldom diagnosed preoperatively and can cause significant intra-operative complications and require higher degree of awareness on the part of operating surgeon.On literature review, only nine cases of the right posterior sectoral duct opening into the choledochal cyst are reported [1][2][3][4][5][6][7][8]. AHD is not easily detected on cholangiography as it may be displaced by the choledochal cyst or may be overshadowed by the denser image of the choledochal cyst

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“…Choledochal cyst association with aberrant hepatic duct (AHD) is rarely reported [1,2]. A 14-year-old female presented with the complaint of recurrent abdominal pain since 6 months.…”

Section: Case Summarymentioning

confidence: 99%

Section: Case Summarymentioning

confidence: 99%

mentioning

confidence: 99%

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Choledochal Cyst with Aberrant Right Posterior Sectoral Duct

Singh

Goyal

et al. 2013

Indian J Surg

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“…Accessory hepatic ducts (AHDs) are extrasegmental bile ducts that often drain a part of the liver and can join the biliary system at any position, such as the common bile duct, common hepatic duct (CHD), right hepatic duct or the gallbladder. AHDs are seldom seen on preoperative imaging, but they increase the difficulty of surgery and the risk of postoperative biliary fistula 5 6. A retrospective analysis of treatment outcome in 7 of 542 patients with AHDs who received surgical treatment in our center from January 2012 to August 2020 was conducted.…”

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confidence: 99%

“…The presence of AHDs is identified by the presence of small ducts or bile leakage during surgery (figure 4). The Japanese scholar Takahashi5 summarized five CBD cases of AHDs: only one case was found during intraoperative imaging, one case was found by repeated endoscopic retrograde cholangiopancreatography (ERCP) imaging, and the rest were found by intraoperative or postoperative biliary fistula. It has been reported in the literature that more cases of AHD were found due to bile leakage during surgery or due to the postoperative complication of biliary fistula 6 11.…”

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confidence: 99%