Choledochal Cyst (CDC)

Hamid, Raashid; Bhat, Nisar Ahmad; Ahmad, Mansoor; Singh, Balvinder

doi:10.5772/intechopen.72938

Cited by 4 publications

(2 citation statements)

References 34 publications

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“…Though giant calculus of the gallbladder is common, giant calculus in the CBD is rare [ 5 ]. Only few cases of giant biliary calculus in the CBD measuring 5 cm or more have been published (Table 1 ) [ 2 , 3 , 4 , 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The presence of such a giant calculus without an associated jaundice is rare [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Giant Calculus with More than 100 Small Calculi in Choledochal Cysts

Bahadur¹,

Thakur

Bains

et al. 2021

Case Rep Gastroenterol

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Giant biliary calculus in the common bile duct (CBD) is rare. Giant calculus of choledochal cyst (CC) is even rarer, and no case of giant calculus of CC with more than 100 calculi has been reported in the indexed literature. We present the case of a 8.0 × 4.5 × 4.0 cm sized giant calculus with >100 small calculi in type IVa CCs with heterotopic pancreas in a 45-year-old male, which is a surprisingly rare occurrence. Magnetic resonance cholangiopancreatography showed multifocal irregular dilatation of intrahepatic biliary radicles with multiple filling defects with a giant calculus in CC with cholelithiasis. The case was successfully managed with open cholecystectomy and choledochotomy with retrieval of 1 giant and more than 100 small calculi with excision of CC with Roux-en-Y hepaticojejunostomy. Histopathological examination (HPE) showed inflamed CC identified with focal areas of surface ulceration with increased fibrosis areas in the wall and few pancreatic acini. A bile duct calculus is defined as “giant” when the size is 5 cm or more. Stone formation within is the most frequent complication of CC. Most intracystic calculi have been described as soft, earthy, and pigmented in appearance, supporting bile stasis as a primary etiologic factor. The only treatment for giant calculus of CBD or CC is surgical. Endoscopic treatment is mostly unsuccessful and open surgery is the treatment of choice due to giant size, increased load of calculus, and presence of calculi in the left and right hepatic ducts.

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Section: Discussionmentioning

confidence: 99%

Giant Calculus with More than 100 Small Calculi in Choledochal Cysts

Bahadur¹,

Thakur

Bains

et al. 2021

Case Rep Gastroenterol

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“…"Long common channel" theory by Babbit has been the most accepted explanation for the origin of the choledochal cyst. This theory states that the pancreaticobiliary junction is located outside the duodenal wall [12,13].…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Choledochal Cyst: Clinical Features, Diagnosis and Treatment Perspectives

Torres¹,

Becerra²,

Calderón³

et al. 2023

Biliary Tract - Review and Recent Progress

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Choledochal cyst is a congenital or acquired anomaly affecting the biliary tree in which exists a dilatation of the bile duct, not only the choledochus is affected but also the intrahepatic and extrahepatic ducts might be affected. The clinical presentation is not specific, even the classic triad with abdominal pain, mass, and jaundice is not common as suspected, found only in 10% of cases. Clinicians must rely on imaging studies for diagnosis and classification. The treatment is cyst excision with hepaticoenterostomy in most of the cases, but in some others, a liver transplant would be necessary. These patients require lifelong follow-up due to its rate of recurrence compared with general population.

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Simultaneous choledochal cyst excision and pancreaticojejunostomy (Puestow’s technique) for type IA cyst with associated chronic pancreatitis: a case report

Bashir,

Abbas,

Khan

2024

Egypt Liver Journal

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Introduction and importance Choledochal cysts are congenital conditions that affect the biliary tree, typically identified during childhood. These cysts present as dilations in the biliary system, occurring either in the extrahepatic or intrahepatic regions or in some cases, in both areas. Occasionally, it may have associated chronic pancreatitis posing a challenge to the management of both conditions. In the case reported, a female child was diagnosed with a choledochal cyst along with chronic pancreatitis. She had an excision of cyst and lateral pancreaticojejunostomy simultaneously for both conditions resulting in favorable outcomes. Case presentation An 8-year-old child visited the clinic with a complaint of upper abdominal pain accompanied by intermittent vomiting. An ultrasound was performed which showed a dilated common bile duct. To confirm the diagnosis, an MRCP and baseline labs including liver function tests were ordered. The findings were suggestive of a type IA choledochal cyst with concomitant chronic pancreatitis. Subsequently, she had choledochal cyst excision with Roux-en-Y hepaticojejunostomy reconstruction plus lateral pancreaticojejunostomy using the classical Puestow’s technique. The patient’s recovery post-surgery was uneventful, resulting in discharge on the fifth post-operative day for routine outpatient follow-up. Clinical discussion Patients afflicted with choledochal cysts are prone to recurrent pancreatitis, though the precise underlying mechanism is unknown. Certain studies propose an association between abnormal pancreatico-biliary junction and recurrent pancreatitis, often defined as a common channel surpassing 15 mm in length. However, this aberration could not be definitively established in the current case. Diagnosis of choledochal cysts can be confirmed through either ERCP or MRCP, with the latter preferred due to its non-invasive nature. The optimal management strategy for choledochal cysts necessitates cyst resection and Roux-en-Y hepaticojejunostomy reconstruction Moreover, in cases associated with chronic pancreatitis, longitudinal pancreatojejunostomy may be undertaken. Conclusion Thus, it is concluded that although rare choledochal cysts may have associated chronic pancreatitis. Surgical excision of the cyst and lateral pancreaticojejunostomy can be performed simultaneously resulting in favorable post-operative outcomes.

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Choledochal Cyst (CDC)

Cited by 4 publications

References 34 publications

Giant Calculus with More than 100 Small Calculi in Choledochal Cysts

Giant Calculus with More than 100 Small Calculi in Choledochal Cysts

Choledochal Cyst: Clinical Features, Diagnosis and Treatment Perspectives

Simultaneous choledochal cyst excision and pancreaticojejunostomy (Puestow’s technique) for type IA cyst with associated chronic pancreatitis: a case report

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