Congenital Choledochal Dilatation With Emphasis on Pathophysiology of the Biliary Tract

Iwai, Naoharu; Yanagihara, Jun; Tokiwa, Kazuyasu; Shimotake, Takashi; Nakamura, Kaori

doi:10.1097/00000658-199201000-00003

Cited by 122 publications

(90 citation statements)

References 4 publications

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“…Consequent chemical and enzymatic destruction of the duct wall leads to cystic dilation [17,18] . Iwai [19] and other authors [16,18] found that the choledochal dilation has a close association with abnormal choledochopancreaticoductal junction, whether direct or indirect. CT can clearly visualize cyst location, number, scope, stone and relationships with surrounding structures.…”

Section: Discussion Diagnosismentioning

confidence: 93%

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

Li-ming

Peng²,

Meng³

et al. 2001

WJG

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AIM To summarize the experience of diagnosis and treatment of congenital choledochal cyst in the past 20 years .METHODS The clinical data of 108 patients admitted from 1980 to 2000 were analyzed retrospectively.RESULTS Abdominal pain, jaundice and abdominal mass were presented in most child cases. Clinical symptoms in adult cases were non-specific, resulting in delayed diagnosis frequently. Fifty-seven patients (52.7%) had coexistent pancreatiobiliary disease. Carcinoma of the biliary duct occurred in 18 patients (16.6%). Ultrasonic examination was undertaken in 94 cases, ERCP performed in 46 cases and CT in 71 cases. All of the cases were correctly diagnosed before operation. Abnormal pancreatobiliary duct junction was found in 3 9 p a t i e n t s . B e f o r e 1 9 8 5 t h e d i a g n o s i s a n d classification of congenital choledochal cyst were established by ultrasonography preoperatively and confirmed during operation, the main procedures were internal drainage by cyst enterostomy. After 1985, the diagnosis was established by ERCP and CT, and cystectomy with Roux-en-Y hepaticojejunostomy was the conventional procedures. In 1994, we reported a new and simplified operative procedure in order to reduce the risk of choledochal cyst malignancy. Postoperative complication was mainly retrograde infection of biliary tract, which could be controlled by the administration of antibiotics, there was no perioperative mortality.CONCLUSION The concept in diagnosis and treatment of congenital choledochal cyst has obviously been changed greatly. CT and ERCP were of great help in the classification of the disease. Currently, cystectomy with Roux-en-Y hepaticojejunostomy is strongly recommended as the choice for patients with type I and type IV cysts. Piggyback orthotopic liver transplantation is indicated in type V cysts (Caroli's disease) with frequently recurrent cholangitis.

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Section: Discussion Diagnosismentioning

confidence: 93%

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

Li-ming

Peng²,

Meng³

et al. 2001

WJG

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“…[18][19][20][21] Many doctors believe that choledochal cyst in older children results from an anomalous insertion of the distal CBD into the pancreatic duct of Wirsung that permits reflux of pancreatic juice into the biliary tree, resulting in cholangitis, which weakens the bile duct wall and leads to cyst formation. 8,21 It has also been suggested that, in infancy, choledochal cyst and BA are part of the spectrum of infantile obstructive cholangiopathy and may be found concurrently in this stage of life. 22 A survey of the American Academy of Pediatric Surgery Section found that 13% of patients with cystic dilatation of the CBD had extrahepatic atresia.…”

Section: Discussionmentioning

confidence: 99%

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Lee

Yeung

Chang

et al. 2000

Journal of Ultrasound in Medicine

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We evaluated sonographically 162 children who met the criteria for biliary tract dilatation in the past 18 years. Of these, 131 patients were diagnosed as having anomalous dilatations of the biliary tree (including 112 with choledochal cysts and 19 with biliary duct dilatation and biliary atresia). Biliary tract dilatations in the other 31 patients were due to secondary causes or normal variants. All cases of intrahepatic biliary tree dilatation and those with both intra‐ and extrabiliary duct dilatations were anomalous. In 117 cases of extrahepatic biliary tract dilatation only, the mean diameter was widest in cases of choledochal cyst (21.4 +/‐ 12.1 mm, compared with cases of biliary tract dilatation with biliary atresia (10 +/‐ 2.4 mm), secondary biliary duct dilatation (8.5 +/‐ 1.5 mm), and normal variants (4.4 +/‐ 1.2 mm) (P < 0.001). Of the 43 infants with biliary tree dilatation, 24 (56%) had choledochal cysts and 19 (44%) had biliary tract dilatation associated with biliary atresia. Excluding cases associated with biliary atresia, the accuracy of diagnosing choledochal cysts in extrahepatic biliary tract dilatation was 71% and 97% using cutoffs of 7 mm and 10 mm as the minimum diameter, respectively.

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“…Consequently, various biliary cancer models were established, that investigate the initiating mechanisms involved in biliary carcinogenesis. Such experimental and clinical tumor models are the liver fluke infection with Opisthorchis viverrini (OV) [2][3][4], models of anomalous arrangement of the pancreaticobiliary ducts (APBD) and bilioenterostomy [5,6], clinical series of patients with congenital bile duct cysts (CBDC) and pancreaticobiliary maljunctions (PBM) [7][8][9] and tumor induction models that use chemical hepatobiliary carcinogens such as N-nitrosobis(2-oxopropyl)amine (BOP) [6,10] or diethylnitrosamine (DEN) [11]. With the introduction of translational research methods (e.g.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of biliary carcinogenesis: A pathogenetic multi-stage cascade towards cholangiocarcinoma

1999

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SummaryCarcinomas of the biliary tract are rare cancers developing from the epithelial or blast-like cells lining the bile ducts. A variety of known predisposing factors and recent experimental models of biliary carcinogenesis (e.g., infection with the liver fluke Opisthorchis viverrini, models of chemically induced carcinogenesis and experimental models of pancreaticobiliary maljunction) have elucidated different stages of this complex system of biliary tumorigenesis. Chronic inflammatory processes, generation of active oxygen radicals, altered cellular detoxification mechanisms, activation of oncogenes, functional loss of tumor-suppressor genes and dysregulation of cell proliferation and cell apoptotic mechanisms have been identified as important contributors in the development of cholangiocarcinomas. In this review, the known mechanisms involved in the carcinogenesis of biliary epithelium are addressed. We will divide the topic into four stages: 1) Predisposition and risk factors of biliary cancer. 2) Genotoxic events and alterations leading to specific DNA damage and mutation patterns. 3) Dysregulation of DNA repair mechanisms and apoptosis, permitting survival of mutated cells and 4) Morphological evolution from premalignant biliary lesions to cholangiocarcinoma. Finally, established and hypothetical future therapeutic strategies directed towards specific pathogenetic events during biliary carcinogenesis will be addressed.

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Congenital Choledochal Dilatation With Emphasis on Pathophysiology of the Biliary Tract

Cited by 122 publications

References 4 publications

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China

Dilatation of the biliary tree in children: sonographic diagnosis and its clinical significance.

Mechanisms of biliary carcinogenesis: A pathogenetic multi-stage cascade towards cholangiocarcinoma

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