Spontaneous Perforation of Choledochal Cyst: A Study of 13 Cases*

Ando, Kunimasu; Miyano, Takeshi; Kohno, Shizuka; Takamizawa, Satoru; Lane, Geoffrey J.

doi:10.1055/s-2008-1071113

Cited by 119 publications

(88 citation statements)

References 7 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ando ve arkadaşları takip ettikleri 187 KK vakasının 13'ünde spontan perforasyon görmüştür (17). Bizim ilk hastamızda kistin aşırı büyümesi, muhtemelen kist basısına bağlı kusma ve karaciğer enzimlerinde yükselme hastanın erken ameliyat edilme sebebidir.…”

Section: Discussionunclassified

Yenidoganin Antenatal Tanili Koledok Kistleri

Türkyılmaz¹

2014

GMJ

View full text Add to dashboard Cite

ÖZETKoledok kistleri karın içinde sağ üst kadran kistik kitlesi olarak görülen biliyer kanalın bir anomalisidir. Prenatal tanılı koledok kistleri ultrasonografi ekipmanlarındaki gelişmeler sonucunda rutin fetal anomali taramalarında artan sıklıkta görülmektedir. Koledok kistlerinin prenatal tanısıdaha az komplikasyonlu erken cerrahi onarıma yol açmıştır. Biz burada prenatal tanılı iki koledok kistini sunarak bu hastalığın tedavisini tartıştık. ABSTRACTCholedochalcyst is one of the intra-abdominal abnormalities of the biliary ducts that present as a cystic mass in the right upper quadrant abdomen. Prenatal diagnosis of fetal choledochal cysts has become more frequent with the improvement of the ultrasound equipment as well as the increased use of routine fetal anomaly scan. Prenatal diagnosis of choledochal cysts is essential since this can lead to earlier surgical repair resulting in less complications. We report two choledochal cysts with prenatal diagnosis and discuss treatment of this disease.

show abstract

Section: Discussionunclassified

Yenidoganin Antenatal Tanili Koledok Kistleri

Türkyılmaz¹

2014

GMJ

View full text Add to dashboard Cite

show abstract

“…The etiological factors that are thought to be the cause of spontaneous CBD perforation in infants are choledochal cysts and anomalous union of the pancreaticobiliary ductal system which results in reflux of pancreatic juices and tissue destruction, distal bile duct stenosis, or atresia leading to congenital weakness of the CBD [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…The sudden increase in the intraluminal pressure also results in decreased blood flow in the vessels which run along the lateral border of the bile ducts, resulting in ischemia on the anterior surface of the bile duct [21].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Perforation of the Common Bile Duct in an Adult

2012

View full text Add to dashboard Cite

Spontaneous perforation of the bile duct is a rare disease in children and even rarer in adults. Although diagnostic techniques have advanced over the past years, yet most cases are diagnosed at operation. A 44-year-old woman presented with epigastric pain and vomiting of one-day duration. Abdominal distension with tenderness and guarding was present all over the abdomen. Abdominal ultrasonography showed free fluid in the peritoneal cavity with sluggish peristalsis. Abdominal and chest radiographs were normal. At laparotomy, common bile duct CBD was perforated at the junction of CBD and cystic duct. Cholecystectomy with CBD exploration was done and CBD was closed over a T-tube, and external drainage was carried out. The patient recovered well, and on the 12th postoperative day, a T-tube cholangiogram was performed which was normal. The T-tube was removed on the 14th postoperative day. One month after operation, the patient was well. Examining the patient with a suspicious thinking helps in early diagnosis and management of the patient.Keywords Spontaneous . Common bile duct . Perforation CBD perforation is uncommon, usually reported in infants due to congenital anomalies. Cases have been reported in adults following invasive procedures in and around the CBD. But spontaneous perforation of CBD occurring in an adult presenting as acute abdomen is an unusual phenomenon. We report one such case which presented as acute abdomen exploratory. Laparotomy was done and CBD was found perforated. CBD was explored and closed over the T-tube and the patient recovered uneventfully (Fig. 1). CaseA 44-year-old woman presented with epigastric pain and vomiting of one-day duration. On examination, the abdomen was distended. There was tenderness and guarding in the whole abdomen. On ultrasound examination, there was moderate free fluid in the peritoneal cavity with sluggish peristalsis. Plain radiograph abdomen and chest were normal. Investigations of complete hemogram, blood urea, serum creatinine, and serum electrolytes were within normal limits.The patient was resuscitated and explored. There was bile mixed with peritoneal fluid in the peritoneal cavity. Whole of small and large bowel was explored and was found normal. A perforation was found in the common bile duct (CBD) near the junction of cystic duct and CBD. Cholecystectomy was done and the CBD was explored. There was no calculus, stenosis, or any malformation of CBD. The CBD was closed over a T-tube. Peritoneal lavage was given and abdomen was closed with a subhepatic drain. Bile culture showed Escherichia coli and Widal was also within normal limits. Patient's ELISA for HIV was normal. Investigations for Mycobacterium tuberculosis were negative. The patient had a smooth recovery in the post-operative period. AT-tube cholangiogram was performed on the 12th post-operative day, which was normal. The T-tube was removed on the 14th postoperative day. The patient was discharged after removal of the T-tube. DiscussionSpontaneous CBD perforations are more commonly report...

show abstract

“…This classic presentation appears less frequently nowadays because of earlier diagnosis and treatment. In children, incidental biliary ascites was reported after spontaneous or traumatic perforation of a choledochal cyst [6]. Biliary carcinoma occurs in 2.5-39.4% of patients with biliary cysts [7,8]: the degenerated mucosa of a choledochal cyst increases the risk for carcinomatous development due to chronic irritation, ulceration and subsequent regeneration of cyst epithelium [9].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Yoon¹

2011

BJR

View full text Add to dashboard Cite

ABSTRACT. Here we describe three cases of choledochal cyst involving the cystic duct or isolated dilatation of the cystic duct. All cases were visualised on MR cholangiopancreatography (MRCP) imaging. We report findings of ultrasonography, CT and MRCP. These cases are extremely rare; nine cases have been reported in the English-language literature. This anomaly was not included in Todani's classifications of choledochal cysts, a system that is accepted worldwide. We think that this variant anomaly will be included in this classification system in the near future. ; normal range ,10 ng ml -1 ) was noted. Initial work-up included a transabdominal ultrasonography, which showed a hypoechoic mass replacing the fundal portion of the gallbladder ( Figure 1a). On abdominal CT, a soft-tissue mass was noted in the fundus of the gallbladder with suspicion of hepatic invasion ( Figure 1b); multiple enlarged lymph nodes were identified in the peripancreatic, portocaval, aortocaval, and left paraaortic regions ( Figure 1b), suggesting the possibility of malignancy.Focal fusiform dilatation of the cystic duct without a definite cause of obstruction was identified and was about 22 mm in diameter and 34 mm in length (Figure 1c).The extrahepatic bile duct and common bile duct were of normal diameter.MR cholangiopancreatography (MRCP) was performed for further evaluation. On thick-slab coronal oblique MRCP imaging, fusiform dilatation of the cystic duct with normal diameters for the intrahepatic and extrahepatic bile ducts was seen (Figure 1d).There was no evidence of bile duct stone or stenosis in the transitional portion of the cystic duct. Also, there was no evidence of definite anomalous union of the pancreaticobile duct (AUPBD). This patient was diagnosed with advanced gallbladder cancer with lymph nodes metastasis combined with choledochal cyst involving the cystic duct only. Case 2A 48-year-old woman was transferred from a local clinic because of bile duct dilatation. The patient complained of intermittent dyspepsia and mild abdominal pain for 6 weeks. But there was no definite tender point or Murphy's sign on physical examination. On CT scan performed at an outside institution, mild wall thickening of the gallbladder was identified with luminal contraction and suspicion of gallbladder stones. Demonstrable dilatation of the common bile duct was present with normal appearance of the intrahepatic bile duct and pancreatic duct. The laboratory findings showed an increased level of total bilirubin (1.2 mg dl ); other laboratory results including serum tumour markers were within normal limits. Abdominal MRI (Figure 2a) and MRCP ( Figure 2b) were performed, showing fusiform dilatation of the common bile duct and cystic duct of about 7 cm in length and 3 cm in diameter; the ducts were joined by a wide opening, but no visible cause of obstruction was identified. There was no evidence of definite AUPBD. After 1 week of clinical observation, the total bilirubin level returned to normal. The patient was conservatively treated for 5 ye...

show abstract

Spontaneous Perforation of Choledochal Cyst: A Study of 13 Cases*

Cited by 119 publications

References 7 publications

Yenidoganin Antenatal Tanili Koledok Kistleri

Yenidoganin Antenatal Tanili Koledok Kistleri

Spontaneous Perforation of the Common Bile Duct in an Adult

Magnetic resonance cholangiopancreatography diagnosis of choledochal cyst involving the cystic duct: report of three cases

Contact Info

Product

Resources

About