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(a) A large fusiform cyst attached to the gallbladder; (b) A diagrammatic sketch to illustrate the cyst of cystic duct relationship to the gall bladder and common bile duct.
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Introduction
Choledochal cyst originating from the cystic duct is a very rare case and difficult to diagnose preoperatively, it is classified as Todani type VI choledochal cyst. Only three cases of type VI choledochal cyst have been reported in the literature.
Presentation of case
A 35-year-old woman came with an enlarged and palpable mass in the...
Context in source publication
Context 1
... the operation, we found different choledochal cyst from those described by Todani classification. We found a large cystic fusiform sized 14 × 14 × 1 cm attached to the gallbladder, the edge of the cyst attached to segment 3, 4, and 5 of the liver (Fig. 3). The gallbladder was contracted and a stone sized 2 cm was found. There is no connection between the cystic duct with CHD or CBD. When the cyst was aspirated, 1000 cc bile fluid was taken out. The cyst wall was thin and there was no sign of calcification. We performed a simple cholecystectomy as well as excision of the ...
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Background
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Citations
... Choledochal cysts are classified into five types, according to Todani 5 . The Todani classification combines the Lej classification and the Caroli disease variation 6 . Ultrasonography (USG) is used as an initial examination of the choledochal cyst, followed by a computed tomography (CT) scan. ...
... The walls of the biliary ducts will weaken due to prolonged exposure to pancreatic enzymes. This reflux is due to abnormalities in the pancreaticobiliary duct relationship (Choledochalpancreatic or pancreatic-choledochal). 6,8,10 Diagnosis of choledochal duct cysts in this patient was made based on physical examination, laboratory, and CT scan imaging. According to Hakimi, if there isn't a CT scan, an initial examination can be done with an ultrasound examination (USG), which is a cheap, non-invasive, but subjective modality. ...
p> Introduction : Choledochal cysts that are accompanied by obstructive jaundice are a rare case. These cysts can cause intrahepatic or extrahepatic ductal dilatation. Their diagnosis is difficult, particulary in adults. Proper management can prevent further complications.
Methods: A serial case report of a patient with a choledochal cyst.
Results : 2 female patients aged 21 years and 22 years have a painful and fixed lump in the upper right abdomen. The first patient also complained jaundice. Laboratory results showed an increase in total bilirubin and direct bilirubin. The second patient didn’t complaint about jaundice or increased bilirubin, and she had a cholecystectomy when she was ten. The diagnosis was confirmed by a contrast abdominal CT scan, showing type 1A Todani choledochal cysts in both patients. Management of the first patient was cyst excision, cholecystectomy, and Roux n Y hepaticojejunostomy. In the second patient, adhesiolysis, cyst excision, and Roux n Y hepaticojejunostomy were performed. The second patient had no postoperative complications.
Conclusion : Choledochal cysts are a rare congenital condition in adulthood. n both cases, two patients were manage surgically. Bile leakage complications can be manage conservatively. Diagnostic and management of choledochal cysts must be correct to prevent pitfall and complications.</p
... The description of surgical interventions was reported in 27 patients only. These were laparoscopic cholecystectomy (9 cases) [12,14,15,21,23,27,32,33,38], open cholecystectomy (10 cases) [16,19,20,22,25,[34][35][36][37]39], robotic cholecystectomy (1 case) [18]., open external biliary tree excision with hepaticojejunostomy (5 cases) [12,24,28,30,31], laparoscopic external biliary tree excision with hepatico-jejunostomy (1 case) [24], laparoscopic converted to open cholecystectomy with liver wedge resection and regional lymph node clearance (1 case) [17]. The type of surgical intervention was not reported in 5 cases. ...
Over the past two decades, there have been an increasing number of reports describing a sixth type of choledochal cyst (cystic duct cyst) in adults that was not included in Todani’s classification. This sixth entity has not yet been systematically reviewed in the literature. We therefore explored this condition in adults from the perspective of the clinical presentation, diagnosis and treatment through a systematic review of the evidence. The final analysis included 33 reported cases, with 55% of them reported in Asia. The mean age was 39.3 years old, with a female-to-male ratio of 1.5:1. Magnetic resonance cholangiopancreatography was accurate in establishing the diagnosis in 69% of cases. Where reported, standard laparoscopic/open cholecystectomy was performed in about 74% of patients, while around 25% of them needed extensive surgery. Associated malignancy was reported in 6.1% of cases, while 28% of patients had co-existent gallstone-related disease. No significant post-operative morbidity or mortality was reported. In this era of emergency laparoscopic cholecystectomy, surgeons should be aware of this rare condition, with the particular understanding that it is associated with gallstone-related disease in a significant number of reported cases.
... [7] Additionally, type VI (including BC of the isolated cystic duct) has been described. [8] BC need surgery to avoid complications associated with pancreaticobiliary reflux. It depends on the cyst type. ...
Rationale:
Biliary cysts (BC) are rare dilatations of various parts of a biliary tract. They account for approximately 1% of all benign biliary diseases. Total cyst excision and Roux-Y hepaticojejunostomy is the treatment method of choice in most patients. In this paper, a novel surgical treatment with the use of internal biliary and pancreatic catheters was presented.
Patient concerns:
A 21-years-old woman with a giant choledochal cyst of Todani IA type presenting with abdominal pain, nausea, fever and palpable abdominal mass. It had been previously drained as a misdiagnosed pancreatic cyst in another hospital.
Diagnosis:
A very high amylase level (107140,0 U/l) in drain fluid was noted in laboratory tests. Endoscopic retrograde cholangiopancreatography revealed a biliary cyst located in the distal common bile duct and a pancreaticobiliary anomaly was suggested. A cholangiography per catheter inserted to the biliary cyst showed a large round contrast-filled cyst. A cholangiography following cyst decompression revealed a very long, tortuous bile duct entering the duodenum.
Interventions:
Cholecystectomy, cyst resection, Roux-Y hepaticojejunostomy, and implantation of catheters into pancreatic and bile duct were performed. The postoperative course was uneventful and she was discharged on 12th day without any complications. Histopathology revealed a cyst wall partially lined with biliary-type and mucinous epithelium, with dysplasia ranging from low to high grade (biliary intraepithelial neoplasia, high grade), without invasion.
Outcomes:
The biliary and pancreatic catheters were removed during endoscopic retrograde cholangiopancreatography 8 weeks following surgery without any complications. Fourteen months later, the patient reported good health.
Lessons:
Diagnosis of the abdominal cyst should be very precise in order to avoid misdiagnosis and inadequate management. The early diagnosis and proper treatment of BC are needed in order to avoid serious complications. The cholangiocarcinoma is the most dangerous potential complication of BC due to dysplasia within the cyst wall as in our young female patient.
... Some authors created additional types other than original Todani's classification, such as type Id [3] and type VI. [4][5][6] However, there is no consensus on clear definition of additional types and most patients can be categorized into classical anatomical types. Surgical approaches can be planned individually according to different types. ...
Background: The commonly used anatomical classification of congenital biliary dilatation by Todani is not directly related to types of pancreaticobiliary maljunction (PBM). This work is to investigate clinical presentation and surgical outcomes according to PBM classification proposed by the Japanese Study Group on Pancreaticobiliary Maljunction. Pancreaticobiliary junction angle, common channel length, and diameter of dilatation are studied as well.
Materials and Methods: Patients of redo operation, without preoperative images, and lacking clearly documented outcomes were excluded. After exclusion, 79 patients who underwent Roux-en-Y hepaticojejunostomy between January 1994 and December 2019 were enrolled for this retrospective study. Medical records were reviewed, and perioperative parameters were collected. Todani's classification, PBM types, pancreaticobiliary junction angle, common channel length, and dilatation diameter were determined based on magnetic resonance cholangiopancreatography or computed tomography. Clinical presentation and outcome were compared between groups of different anatomical features.
Results: PBM type A (stenotic), type B (nonstenotic), and type C (dilated channel) consisted of 48 (60.8%), 18 (22.8%), and 11 (13.9%) patients, respectively; and two patients (2.5%) had no PBM. Patients of PBM type A were younger and had more Todani's type Ia lesion. Patients of PBM type B and C had either Todani's type Ia or Ic lesion, but type IVa had only PBM type B. Longer common channel (1.27 vs. 0.81 cm, P < 0.001) and wider dilatation (4 vs. 2 cm, P < 0.001) were found in patients with right pancreaticobiliary angle (90°). Clinical outcome was similar in different Todani's types, PBM types, and pancreaticobiliary angle. Serum alkaline phosphatase level higher than 675 U/L was associated with major perioperative complications. Preoperative jaundice, mass, and dilatation wider than 5 cm were related to subsequent liver cirrhosis.
Conclusion: PBM types and pancreaticobiliary junction groups are feasible for surgical planning, but not related directly to outcome. Palpable abdominal mass suggests higher risk of perioperative and late complications. For subsequent liver cirrhosis, laboratory data of disease onset and dilatation diameter wider than 5 cm are important risk factors.
Purposes: Dilatation of cystic duct is very rare and had been classified as Todani type VI choledochal cyst. Choledochal cyst combined with dilatation of cystic duct is difficult to diagnose preoperatively. The purpose of this study is to report the rare variants and discuss the significance and laparoscopic management strategy in children. Methods: The subjects for this study were 10 consecutive patients with type VI choledochal cyst who had laparoscopic procedures at our institute between January 2009 and January 2023. Laparoscopic cholecystectomy, excision of the dilated cystic duct, and choledochal cyst were carried out, and the continuity of the biliary duct was re-established through a Roux-en-Y hepaticojejunostomy. Results: Cystic duct combined with the common bile duct dilatation was revealed in all the patients intraoperatively. Laparoscopic procedures were completed with no conversions. The postoperative recovery was uneventful. The mean follow-up duration was 27 ± 12.7 months (range 5-36 months) with no postoperative complications encountered. Conclusions: The rare entity of type VI choledochal cyst should be recognized as a distinct type of choledochal cyst and need to be given enough attention clinically. The laparoscopic procedure is a feasible option for experienced surgeons.
Type II choledochal cysts are rare, representing approximately 2% of cases.¹⁻³ Even fewer cases of type II cysts involving the cystic duct have been reported. Excision is necessary to prevent future ascending cholangitis, liver fibrosis, and malignancy.1-3, 5 We present a case of a 3 month old male born premature who presented with persistent conjugated hyperbilirubinemia. Imaging workup demonstrated a cystic structure at the neck of the cystic duct, measuring 0.9 cm × 1.6 cm x 0.9 cm. Delayed biliary excretion was noted on HIDA. Decision was made to take the patient to the operating room for a cholecystectomy and intraoperative cholangiogram to delineate the anatomy. Intraoperatively, the patient was found to have a small cystic structure arising from the cystic duct. A cholecystectomy was performed and the patient recovered well. Choledochal cysts of the cystic duct are considered type II cysts based on the original Todani Classification. Due to their location, cholecystectomy is required during excision. 1-3, 5 Wide-based cysts involving the common bile duct additionally require hepaticojejunostomy [[1], [2], [3],5]
Introducción: Los quistes de colédoco son dilataciones congénitas raras en cualquier segmento del árbol biliar, con una incidencia de aproximadamente 1:100.000 a 1:150.000 nacidos vivos, siendo más frecuente en países asiáticos, con mayor frecuencia en el sexo femenino (4:1), el 80% de los casos se diagnostican en la infancia y el 20% en adultos en los cuales suele estar asociado a otra patología biliar; el primer caso documentado fue reportado por Douglas en 1852. Objetivo: Describir un caso clínico de quiste del colédoco Material y métodos: Estudio descriptivo retrospectivo presentación de caso clínico. Resultados: Se presenta al caso de una paciente de 23 años que acude por presentar dolor abdominal intenso tipo cólico que se acompaña de diarreas, vómitos e ictericia generalizada. Conclusiones: A pesar de que el quiste de colédoco sea una entidad rara el galeno debe tenerlo en cuenta en pacientes jóvenes que presenten sintomatología que se correlacione con la patología, de la misma manera el uso de ecografía abdominal ante la sospecha ya que el acceso universal disminuye el tiempo de diagnóstico y una intervención oportuna
