Some considerations for management of choledochal cysts†

Jordan, Paul H.; Goss, John A.; Rosenberg, Wade R.; Woods, Karen

doi:10.1016/j.amjsurg.2004.04.004

Cited by 52 publications

(34 citation statements)

References 25 publications

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“…It is theorized that the presence of an anomalous pancreatobiliary junction with a long common duct (>15 mm in more than 80% of cases) without obstruction could be considered as the initiating factor, increasing the risk of chronic retrograde passage of pancreatic secretions into the common bile duct, which leads to dilatation at least, as in our case [3, 7]. …”

Section: Discussionmentioning

confidence: 86%

“…Cholangiocarcinoma may develop in all kinds of cysts, but type I (80% of all patients with CC) and type IV cysts are associated with a higher incidence, even after cyst excision. Jordan et al calculated that the development of bile duct carcinoma in residual CC walls was significantly higher (121.5 times) than in the normal population [7]. Nevertheless, complete excision of these lesions is the treatment of choice as soon as possible, preferably before puberty, in order to decrease the chance of developing cancer [9].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation of this disease is not specific: adult subjects are asymptomatic or usually present with vague symptoms, generally in the right upper abdominal quadrant; rarely they present with the triad of right upper quadrant pain, abdominal mass, and jaundice [7]. About 50% of patients have undergone cholecystectomy or other biliary surgical exploration before diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…At present, total resection of the cyst followed by Roux-en-Y hepaticojejunostomy is the operation of choice: this procedure decreases the risk of biliary stasis (with subsequent gallstone formation, cholangitis and pancreatitis) [7] and the chances of developing cholangiocarcinoma [11]. On these bases, treatment of CC by complete cyst resection and restoration of biliary drainage by Roux-en-Y end-to-end hepatico-jejunostomy is a concept that has gradually gained acceptance throughout the world.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Coledochal Cyst Associated with an Aberrant Posterior Hepatic Duct: Report of a Case and Brief Literature Review

Geraci

Nigro

Sciuto

et al. 2011

Case Rep Gastroenterol

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Choledochal cysts (CCs) are rare congenital cystic or fusiform dilatations of the biliary tree that can involve the extrahepatic and/or intrahepatic biliary tree. We report a case of huge type I CC associated with an aberrant posterior hepatic duct. A 52-year-old man presented with a 3-week history of upper right abdominal pain and jaundice and serologic sign of obstructive jaundice. Ultrasonography (US), magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed with the diagnosis of CC type I according to the classification of Alonso-Lej and Todani-Watanabe. The indication for surgical resection was posed. The cyst was completely resected and the biliary tract was reconstructed with a double hepatico-jejunostomy using the same Roux limb, since during the surgical dissection a before unrecognized anatomical variation of the right biliary tree (aberrant posterior hepatic duct at VI–VII segment) was identified. The diagnosis of CC is often difficult and US and magnetic resonance cholangiopancreatography are necessary to definite biliary dilatation. Endoscopic retrograde cholangiopancreatography should be the most definitive and reliable procedure for the diagnosis and treatment of bilio-pancreatic disorders. Gold standard treatment is surgery (bilio-jejunostomy) and frozen-section histology should be performed to rule out the presence of cancer. In conclusion, surgery is the gold standard for the treatment of CC type I and does not depend on the age of patients, based on a substantial lifetime risk of developing cholangiocarcinoma. Preoperative study is mandatory to assess the biliary tree morphology and to research any anatomical variation.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Coledochal Cyst Associated with an Aberrant Posterior Hepatic Duct: Report of a Case and Brief Literature Review

Geraci

Nigro

Sciuto

et al. 2011

Case Rep Gastroenterol

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“…Occasionally, bile duct complications such as an aberrant bile duct and confluence of the left and right hepatic ducts into a dilated choledochal cyst are observed 1-4. Whether such abnormalities are associated with postoperative complications is of great concern.…”

Section: Introductionmentioning

confidence: 99%

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

Dong¹,

Jiang²,

Zhang³

et al. 2006

Yonsei Med J

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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.

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Meta-analysis of risk of developing malignancy in congenital choledochal malformation

Hove

Meijer

Hulscher

et al. 2018

British Journal of Surgery

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BackgroundCholedochal malformations comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. Choledochal malformation is generally considered a premalignant condition, but reliable data on the risk of malignancy and optimal surgical treatment are lacking. The objective of this systematic review was to assess the prevalence of malignancy in patients with choledochal malformation and to differentiate between subtypes. In addition, the risk of malignancy following cystic drainage versus complete cyst excision was assessed.MethodsA systematic review of PubMed and Embase databases was performed in accordance with the PRISMA statement. A meta‐analysis of the risk of malignancy following cystic drainage versus complete cyst excision was undertaken in line with MOOSE guidelines. Prevalence of malignancy was defined as the rate of biliary cancer before resection, and malignant transformation as new‐onset biliary cancer after surgery.ResultsEighteen observational studies were included, reporting a total of 2904 patients with a median age of 36 years. Of these, 312 in total developed a malignancy (10·7 per cent); the prevalence of malignancy was 7·3 per cent and the rate of malignant transformation was 3·4 per cent. Patients with types I and IV choledochal malformation had an increased risk of malignancy (P = 0·016). Patients who underwent cystic drainage had an increased risk of developing biliary malignancy compared with those who had complete cyst excision, with an odds ratio of 3·97 (95 per cent c.i. 2·40 to 6·55).ConclusionThe risk of developing malignancy among patients with choledochal malformation was almost 11 per cent. The malignancy risk following cystic drainage surgery was four times higher than that after complete cyst excision. Complete surgical resection is recommended in patients with choledochal malformation.

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Some considerations for management of choledochal cysts†

Cited by 52 publications

References 25 publications

Surgical Treatment of Coledochal Cyst Associated with an Aberrant Posterior Hepatic Duct: Report of a Case and Brief Literature Review

Surgical Treatment of Coledochal Cyst Associated with an Aberrant Posterior Hepatic Duct: Report of a Case and Brief Literature Review

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

Meta-analysis of risk of developing malignancy in congenital choledochal malformation

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