Spontaneous Arteriocholedochal Fistula as a Cause of Life-Threatening Hemobilia in a Type I Giant Choledochal Cyst: A Case Report on an Unusual Situation Requiring Whipple’s Pancreatoduodenectomy

Ahmad, Humaid; Bajwa, Moazzum; Lutfi, Irfan; Haider, Jahanzaib; Alam, Shams Nadeem

doi:10.7759/cureus.5441

Cited by 4 publications

(2 citation statements)

References 12 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the removal of intrapancreatic cysts can significantly increase the risk of pancreatic duct injury. Hence, some surgeons could also consider partial hepatectomy and pancreatoduodenectomy to achieve a complete resection [28]. However, if the operator or patient does not agree to sacrifice the normal liver or pancreas, or is reluctant to bear the risk of different associated complications, partial resection can only serve as a second choice.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases

Xiao

Chen

Hong

et al. 2022

Journal of Oncology

View full text Add to dashboard Cite

Background. The choledochal cyst (CC) is a rare cystic dilatory condition with malignant tendency, which is more frequently reported in children. Surgical resection of cysts can significantly decrease the risk of malignancy and reduce associated complications. However, CC has been paid lesser attention in adults, and its surgical parameters have been frequently reported to be in dispute. This study aimed to report experience associated with the treatment of an adult with CC and to suggest the appropriate parameters for the surgery, including the extent of excision (complete or not), the length of the Y limb, the diameter of the cholangio-intestinal anastomosis (CIA), and different operative approaches (open, laparoscopic, and laparoscopic converted to open) by comparing the various indicators, including postoperative bile leakage, cholangitis, choledocholithiasis, carcinogenesis, and surgical re-excision. Methods. We conducted a single-center noninterventional retrospective study of 69 different congenital choledochal cyst patients who were admitted to our hospital between July 2010 and July 2020. We collected and analyzed their demographic data, clinical presentations, underlying complications, imaging tests, endoscopic interventions, and parameters for the surgery, histological data, and prognostic indicators over a mean 77-month follow-up period. Results. We found that out of the 69 cases, the median age at diagnosis was 32 (IQR = 22–45) years. Seven (10.1%) patients were asymptomatic before the diagnosis, with abdominal pain as the primary complaint in 62 (89.9%) patients, whereas nausea/vomiting was observed in 29 (42.0%) patients. CCs were mainly evaluated by using magnetic resonance cholangiopancreatography (MRCP) (n = 47, 68.1%). It was observed that surgery, cholecystectomy, choledochal cysts excision, and Roux-en-Y hepaticojejunostomy (n = 65, 94.2%), and laparotomy (n = 58, 84.1%) were the dominant therapeutic modalities employed. However, seventeen (24.6%) patients were treated with incomplete cyst resection, while 52 (75.4%) patients received complete cyst resection. We also conducted regular follow-ups after the surgery for a mean duration of 77 months. Postoperative complications were found to be experienced by 35 (50.7%) patients, and a further two patients (2.9%) developed malignancy during the follow-up. Moreover, increasing the diameter of cholangio-intestinal anastomosis served as a potential protective factor for postoperative choledocholithiasis ( p = 0.040) and a risk factor for cholangitis ( p = 0.002). Conclusions. Among the 69 CC participants, abdominal pain was their major symptom. Those with an abnormal pancreaticobiliary junction were more likely to have choledocholithiasis and pancreatitis. The diagnosis was found to be highly dependent on the Todani classification scheme and MRCP. Surgical resection remains the key to CC treatment. The results suggested that the complete resection, the length of the Y limb of 40 cm–60 cm, and the diameter of the CIA of 1.0 cm–1.5 cm were appropriate values for predicting the lower risk of postoperative complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases

Xiao

Chen

Hong

et al. 2022

Journal of Oncology

View full text Add to dashboard Cite

show abstract

“…The pathogenesis, treatment measures, and prognosis of these two are quite different, and even complicated by severe abdominal infection, bleeding, and even death. However, the current definition and grading of PF, especially CR-POPF that have a greater impact on the patient’s recovery, can only be accurately diagnosed after a long period of surveillance, which is just dependent on time ( 10 , 24 ). Early diagnosis of CR-POPF after surgery remains a vital issue.…”

Section: Methodsmentioning

confidence: 99%

Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

Chen

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) remains a severe and challenging complication of pancreaticoduodenectomy (PD). This study aimed to establish a novel postoperative nomogram-based diagnostic model for the early detection of CR-POPF in patients subjected to PD.MethodsConsecutive patients who underwent PD in Zhongshan Hospital, Fudan University from December 2018 to October 2020 were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CR-POPF. Then, a novel predictive nomogram was established accordingly.ResultsAmong the consecutive 176 patients who underwent PD, 37 (21.1%) patients developed CR-POPF. Through univariate and multivariate analyses, the drain amylase (P = 0.002), serum creatinine (P = 0.009), and serum C reactive protein (P = 0.045) at postoperative day 1 (POD1) as well as the neutrophil count (P = 0.025) and temperature (P = 0.025) at POD3 were identified as independent risk factors for CR-POPF. Based on this, a novel predictive nomogram containing these factors was constructed to predict the probability of CR-POPF after PD. The formulated nomogram showed better performance to detect CR-POPF after PD with a sensitivity of 0.784, specificity of 0.770, positive predictive value of 0.475, and negative predictive value of 0.930 when compared to other predictors. In addition, the predictive value of the nomogram was assessed by a concordance index of 0.814 (95% CI, 0.736–0.892), which was significantly higher than indicators alone. This was further validated and depicted by decision curve analysis and clinical impact curve.ConclusionThis study established a diagnostic nomogram of postoperative objective parameters that can predict the development of CR-POPF after PD with a good discriminative ability and predictive accuracy.

show abstract

Tactics, techniques, and challenges in the management of giant choledochal cyst in adolescents and adults: a retrospective cohort study

Kumar

Singla

Kumar

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

Spontaneous Arteriocholedochal Fistula as a Cause of Life-Threatening Hemobilia in a Type I Giant Choledochal Cyst: A Case Report on an Unusual Situation Requiring Whipple’s Pancreatoduodenectomy

Cited by 4 publications

References 12 publications

Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases

Surgical Management and Prognosis of Congenital Choledochal Cysts in Adults: A Single Asian Center Cohort of 69 Cases

Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

Tactics, techniques, and challenges in the management of giant choledochal cyst in adolescents and adults: a retrospective cohort study

Contact Info

Product

Resources

About