Management Strategy for Congenital Choledochal Cyst with Co-existing Intrahepatic Dilation and Aberrant Bile Duct As Well As Other Complicated Biliary Anomalies

Abstract

The purpose of this study was to investigate and discuss imaging methods and management strategies for congenital choledochal cyst with co-existing intrahepatic dilation and aberrant bile duct as well as other complicated biliary anomalies. In this study we reviewed and analyzed 72 patients with congenital choledochal cyst, ranging in age from 15 days to 12 years old and who were seen at our hospital during the past 12 years, from January 1993 to October 2005. The image manifestation and clinical significance of patients with coxisting intrahepatic biliary dilation and aberrant bile duct were carefully examined during operation via MRCP, cholangiography and choledochoscope. Twenty-two cases (30.1%) presented with intrahepatic bile duct dilation and 12 of these were of the cystic type. That is, the orifice of the dilated intrahepatic tract that converged into the common hepatic duct showed membrane or septum-like stenosis. In 10 cases the dilation tapered off from the porta hepatis to the initiating terminals of the intra-hepatic bile ducts and was not accompanied by stenosis. An aberrant bile duct was observed in 2 of the cases. In 3 cases, the right and left hepatic ducts converged at the choledochal cyst. In conclusion, the imaging methods for intrahepatic bile duct dilation possess important clinical significance. Further, for hepatojejunostomy with radical excision of a choledochal cyst, additional operative procedures for intrahepatic stenosis, possible bile duct malformation and pancreaticobiliary common duct calculi can potentially reduce postoperative complications.

Kawasaki disease in children and adolescents: clinical data of Kawasaki patients in a western region (Tyrol) of Austria from 2003–2012

“…In our patient cohort, 59.4% were at the age between six months and four years and therefore meet the most common age distribution. The low incidence in the first six months suggests that most infants are protected by acquired maternal antibodies [2]. One patient was diagnosed with incomplete KD at the age of 192 months, whereas all the others were younger than 69 months.…”

“…Coronary artery aneurysms as a sequelae of vasculitis of KD occur in 20–25% of untreated children. In developing countries, KD has replaced acute rheumatic fever as the leading cause of acquired heart disease in children [2, 3]. The classic diagnosis of KD is based on fever for more than five days associated with at least four of the five principle features such as such as polymorphic exanthema, changes of the oropharynx, bilateral non-purulent conjunctivitis, cervical lymphadenopathy and changes to the extremities such as erythema [4].…”

Arrangements of Hepatobiliary Cystadenoma Complicated With Congenital Choledochal Cyst

“…In this study, 53% of the patients were cystic dilation-type; among these, the dilation more frequently occurred in the left lobe of the liver. 21 …”

Normal Anatomy of the Biliary Tree, Gallbladder and Pancreatic Duct

“…Choledochal cysts are rare congenital biliary tract anomalies characterized by cystic or fusiform dilatations of part of the common bile duct and they are often accompanied by intrahepatic bile duct dilatation [25]. Most patients present this disorder during childhood, but presentation later in life is not uncommon [26].…”

“…Resection should include the entire cyst without compromising the pancreatic duct and common channel in order to avoid the risk of malignancy developing in the surgical stump [26]. It should be noted that recent research on the various mechanisms of bile duct carcinogenesis has revealed an association between bile duct cancer and an anomalous pancreatobiliary junction [25]. The diagnostic criteria of choledochal cysts have been adapted from Todani et al [26] (Fig.…”