ABSTRACT
The most common causes of acute pancreatitis are microlithiasis and alcohol. In pediatrics, anomalies in pancreaticobiliary system should be considered as possible causes. Among many anomalies, pancreas divisum associated with anomalous pancreaticobiliary ductal union (APBDU) is very rare. APBDU is associated with acute pancreatitis, choledochal cyst, and gallbladder cancer. Pancreas divisum is also a well known cause of acute recurrent pancreatitis. In adult cases with such conditions, the role of endoscopic management including sphincterotomy or stenting through the Santorini duct is well documented. However, it is still controversial to perform endoscopic retrograde cholangiopancreatography in pediatrics. Herein, we experienced a case of 4 year 7 month old female patient suffered from recurrent attacks of acute pancreatitis, which were caused by APBDU and incomplete pancreas divisum. She was treated by endoscopic sphincteretomy of both openings to the Santorini's and Wirsung's ducts. Thus, we report this interesting case with literature review.
Subject(s)
Child, Preschool , Female , Humans , Abnormalities, Multiple , Acute Disease , Cholangiopancreatography, Endoscopic Retrograde , Common Bile Duct/abnormalities , Pancreas/abnormalities , Pancreatic Ducts/abnormalities , Pancreatitis/diagnosis , Sphincterotomy, Endoscopic , Tomography, X-Ray ComputedABSTRACT
La fístula colecistogástrica es el resultado de una comunicación anómala entre el árbol biliar y el tracto gastrointestinal. Se presenta el caso de un varón de 57 años, sin historial médico relevante, que consulta en urgencias por dolor abdominal y fiebre. El estudio endoscópico demostró una fístula gastrobiliar. Se realizó una laparotomía y se confirmó una fístula colecistogástrica. Se efectuó colecistectomía y reparación de la fístula y el paciente evolucionó bien.
Subject(s)
Humans , Male , Middle Aged , Common Bile Duct/abnormalities , Endoscopy , Gastric Fistula/diagnosis , SpainABSTRACT
Double-barrel common bile duct is rare. We report a 50-year-old woman with defective canalization of the common bile duct, presenting with extrahepatic biliary obstruction due to stones in one compartment. CT scan highlighted this anomaly. After failed attempts at stone extraction at ERCP, she was successfully operated on.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholestasis, Extrahepatic/diagnosis , Common Bile Duct/abnormalities , Female , Humans , Middle AgedABSTRACT
Webs are diagnosed by their characteristic appearance on imaging studies, typically appearing as thin, radiolucent rings with or without dilatation of the organ proximal to it. Like in other organs, the etiology of webs in the common bile duct is controversial. Some webs are thought to be congenital, whereas others occur in the presence of chronic inflammation, suggesting a pathogenic relationship. We report a case of a common bile duct septum in association with numerous large black pigment stones in a 62-year-old woman. The patient was treated by cholecystectomy with T-tube insertion.
Subject(s)
Female , Humans , Middle Aged , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/complications , Common Bile Duct/abnormalities , English AbstractABSTRACT
Background: The Common Channel Syndrome (CCS) is defined as the union of the biliary and pancreatic ducts outside of the duodenal wall with a common duct more than 15 mm long. It is classified morphologically in types 1 and 2, whether it is the biliary or the pancreatic duct the one that predominates. CCS is uncommon in Western countries. It is described particularly in children and has not yet been reported in Chile. Aim: To report the frequency of CCS among patients subjected to endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods: Between 1992 and 1998, 1860 ERCPs were performed for the diagnosis of biliary or pancreatic diseases. Results : In six patients (0.35 percent) a CCS was diagnosed (3 type 1 and 3 type 2). All patients presented with pain and three with jaundice. Four patients had a previous cholecystectomy, three due to cholelithiasis and one due to gallbladder cancer. A common bile duct resection and bilioenteric anastomosis was done in three patients with a favorable outcome. Two patients with an advanced age and one with a gallbladder cancer, were not operated. Conclusions : CCS was found in 0.35 percent of patients subjected to an ERCP. It frequently presents in association with one or more bilio-pancreatic diseases: cholelithiasis, choledocolithiasis, cholangitis, pancreatitis and gallbladder cancer. Resection of the common bile duct and a bilio-enteric anastomosis is proposed as the surgical treatment
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatitis/etiology , Cholangitis/etiology , Common Bile Duct/abnormalities , Pancreatic Ducts/abnormalities , Biliary Tract Diseases/diagnosis , Pancreatic Diseases/diagnosisABSTRACT
El páncreas heterotópico es tejido pancreático que se identifica histológicamente por fuera de los límites topográficos normales y que carece de conexiones anatómicas, vasculares o nerviosas con la glándula principal. Las localizaciones más frecuentes son el estómago, el duodeno y el yeyuno. Es una entidad muy importante por su alto riesgo de complicaciones dentro de las cuales se encuentra la malignización. Se presenta el caso de un paciente joven con ictericia obstructiva, la cual se presumió por causa neoplásica, resultando ectopia pancreática en la vía biliar, la cual es una entidad infrecuente (dos casos previos reportados)
Subject(s)
Common Bile Duct/abnormalities , Pancreas , Tomography, X-Ray ComputedABSTRACT
We report a patient in whom the common hepatic duct drained into the gall bladder body and the cystic duct continued as the bile duct into the duodenum. The anomalous duct was inadvertently injured during laparoscopic cholecystectomy. The injury was repaired and end-to-end anastomosis of the hepatic and cystic ducts was done through a subcostal incision.
Subject(s)
Anastomosis, Surgical , Cholecystectomy, Laparoscopic/adverse effects , Cholelithiasis/surgery , Common Bile Duct/abnormalities , Female , Follow-Up Studies , Humans , Intraoperative Complications/diagnosis , Middle Aged , Treatment OutcomeABSTRACT
La dilatación quística de la vía biliar es una patología poco frecuente en nuestro país. Se presenta la experiencia de 6 casos asistidos por los autores, 3 aportados por el relator y 15 casos del Hospital de Niños de la Plata. Se tratan las controversias sobre la etiología y patogenia de esta afección, diagnóstico y tratamiento. Se realizó una revisión de la bibliografía publicada. De los 6 casos de los autores, 2 fueron hallazgos intraoperatorios; 4 correspondían al tipo I-A y 2 al tipo II de la clasificación de Todani. Se realizó colecistectomía en todos los casos, resección en 4, más hepatoyeyunoanastomosis en 2, quistoduodenoanastomosis 2, drenaje biliar externo en 1 y coledocoduodenoanastomosis en 1. No hubo morbimortandad ni signos de malignización
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Biliary Tract Surgical Procedures , Common Bile Duct Diseases , Common Bile Duct/abnormalities , Choledochal Cyst/surgery , Common Bile Duct Diseases , Common Bile Duct Diseases , Common Bile Duct Diseases/diagnosis , Common Bile Duct/surgery , Postoperative Complications/therapy , Choledochal Cyst/classification , Choledochal Cyst/diagnosis , Treatment OutcomeABSTRACT
Se presentan dos casos de dilatación de la vía biliar, ambos adultos jóvenes, en la tercera década de la vida, uno masculino y otra femenina, que fueron tratados en el Hospital Escuela de Tegucigalpa, D.C. Las anormalidades que presentaban correspondían al tipo IVa y al tipo I de la clasificación de Alonzo-Lej-Toddani, ambos casos cursaron con cuadros recurrentes de dolor abdominal en el cuadrante superior derecho del abdomen y epigastrio y uno de ellos, el tipo IVa, había sido colecistectomizado a la edad de nueve (9) años por dicha sintomatología y fue laparatomizado de urgencia en dos ocasiones por perforaciones del colédoco previo a su cirugía definitiva. El diagnóstico inicial se efectuó, en el tipo IVa por medio de ultrasonografía y fue confirmado mediante colangiografía intravenosa y fue confirmado por ultrasonido. ambos casos fueron sometidos a resección del quiste con reconstrucción por medio de una hepaticoyeyunoanastomosis en "Y" de Roux sin complicaciones trans o postquirúrgicas.
Subject(s)
Adult , Choledochal Cyst/surgery , Choledochal Cyst/complications , Choledochal Cyst/diagnosis , Common Bile Duct/abnormalities , Common Bile Duct/surgeryABSTRACT
Com o objetivo de descrever as alteracoes radiologicas do coledoco terminal na colangiopatia pancreatica cronica, sugere-se uma ppoposta de classificacao colangiografica. A estenose I-A, com extensao maior que 2 cm e dilatacao da via biliar, foi observada em pacientes (24%). O tipo I-B, que nao apresenta dilatacao foi encontrado em 16 casos (64%). Um doente (4%) apresentava estenose do tipo II, aquela com extensao menor que 2 cm. A estenose do tipo III, em formma de ampulheta, tambem foi observada em apenas 1 caso (4%). O tipo IV pode mimetizar uma neoplasia pancreatica, nao tendo sido observado nenhum caso de estenose IV-A, que e a obstrucao completa da via biliar. Em apenas uma ocasiao (4%) foi encontrado o tipo IV-B, obstrucao incompleta
Subject(s)
Humans , Male , Female , Common Bile Duct/abnormalities , Pancreatitis/complications , Common Bile DuctSubject(s)
Child , Cholecystectomy , Cholelithiasis/congenital , Common Bile Duct/abnormalities , Humans , Male , Pancreas/abnormalitiesABSTRACT
Endoscopic retrograde cholangiopancreatograms of 49 patients with chronic pancreatitis (alcohol related 18; idiopathic 31) were assessed retrospectively. Thirteen (72%) of 18 patients with alcohol-related chronic pancreatitis had separate openings of the common bile duct and the main pancreatic duct into the duodenum. This was significantly more frequent (p less than 0.01) than in previously studied controls (37%). Although this finding was seen more frequently in patients with alcohol related chronic pancreatitis than in those with idiopathic chronic pancreatitis (14 of 31, 45%), the difference was not statistically significant. It is concluded that alcohol-related chronic pancreatitis, but not idiopathic chronic pancreatitis, is associated with the presence of separate openings of the common bile duct and main pancreatic duct into the duodenum.
Subject(s)
Adolescent , Adult , Alcoholism/complications , Cholangiopancreatography, Endoscopic Retrograde , Chronic Disease , Common Bile Duct/abnormalities , Female , Humans , Male , Middle Aged , Pancreatic Ducts/abnormalities , Pancreatitis/etiology , Retrospective StudiesABSTRACT
Presentamos dos casos en los cuales el colédoco desemboca en el inicio de la 4ta. porción duodenal, casos de curiosidad anatómica por lo raro de su presentación ya que sólo han sido descritos hasta ahora 2 casos en la Literatura Inglesa. Es importante el conocimiento de estas anomalías, sobre todo para aquellos que trabajan sobre el árbol biliar, para prevenir lesiones del mismo
Subject(s)
Common Bile Duct/abnormalities , Cholangiography , Common Bile Duct , Common Bile Duct/surgery , Postoperative PeriodABSTRACT
With the application of endoscopic retrograde cholangio pancreatography (ERCP), the association of anomalous pancreatobiliary junction and choledochal cyst is being increasingly recognized. We describe here the ERCP findings in three patients who had this anomaly in association with fusiform (Type I) choledochal cyst. Two of our patients also had evidence of pancreatitis. The importance of ERCP in the preoperative assessment of such patients is highlighted.
Subject(s)
Adolescent , Adult , Cholangiopancreatography, Endoscopic Retrograde , Choledochal Cyst/etiology , Common Bile Duct/abnormalities , Female , Humans , Male , Pancreatic Ducts/abnormalitiesABSTRACT
Anatomical variantions of the biliary tract occur frequently enough so as to worry the general surgeon dealing with this problem. Generally speaking, these anatomical variations are not identified prior to surgery. Anamalous drainage of the common hepatic duct into the gall bladder was identified while performing a cholecystectomy. The common bile duct proximal to the cystic duct was a tretic. The problem described above was successfully managed by hepatico-jejunostomy