Resección laparoscópica de dilatación quística congénita del conducto cístico en un paciente pediátrico

Introducción: La dilatación quística congénita del conducto cístico o dilatación tipo VI de la clasificación de Todani, es una variante rara de dilatación congénita de la vía biliar. Objetivo: Explicar la metodología diagnóstica y terapéutica empleada en un caso pediátrico con esta entidad, y destacar la ventaja de su tratamiento oportuno por vía mínimamente invasiva. Presentación del caso: Paciente masculino de 6 años con sintomatología sugestiva de enfermedad vesicular, referido desde la atención secundaria por sospecha de quiste de colédoco. En el ultrasonido se detectaba una lesión ecolúcida adyacente a la vesícula biliar, sin dilatación de las vías biliares intrahepáticas. Se realizó colangiografía laparoscópica y se confirmó una dilatación quística aislada del conducto cístico, la cual se resecó por vía laparoscópica, igualmente. Conclusiones: La incidencia de la dilatación quística del conducto cístico es muy baja y se puede presentar en niños con sintomatología variable. El diagnóstico generalmente es tardío, puede sospecharse mediante la ecografía abdominal y confirmarse con la colangiografía laparoscópica, aun en ausencia de otros medios diagnósticos más modernos. Su reconocimiento y correcta clasificación permiten realizar el tratamiento quirúrgico definitivo exitosamente, de preferencia por vía laparoscópica.

Introduction: Congenital cystic duct dilatation, or Todani classification type VI dilatation, is a rare variant of congenital bile duct dilatation. Objective: To explain the diagnostic and therapeutic methodology used in a pediatric case with this entity, and to highlight the advantage of its timely minimally invasive treatment. Case presentation: Six-year-old male patient with symptoms suggestive of gallbladder disease, referred from secondary care for suspicion of a common bile duct cyst. Ultrasound showed an echolucent lesion adjacent to the gallbladder, without dilatation of the intrahepatic bile ducts. Laparoscopic cholangiography was performed and confirmed an isolated cystic dilatation of the cystic duct, which was resected laparoscopically, likewise. Conclusions: The incidence of cystic dilatation of the cystic duct is very low and may present in children with variable symptomatology. Diagnosis is usually late, can be suspected by abdominal ultrasound and confirmed by laparoscopic cholangiography, even in the absence of other more modern diagnostic tools. Its recognition and correct classification permit a successful definitive surgical treatment, preferably laparoscopically.

Quiste de colédoco con sintomatología obstructiva en embarazada / Common bile duct cyst with obstructive symptoms in a pregnant woman

Los quistes de colédoco son poco comunes, en los países occidentales se ha reportado una incidencia de 1 por cada 100 mil nacidos vivos. En países asiáticos, esta incidencia es mayor, 1 por 100 nacidos vivos. Son usualmente diagnosticados durante la infancia y en el 25 % de los pacientes se presentan durante su vida adulta. Es inusual que se presenten durante el embarazo, sobre todo, que se manifieste durante el primer trimestre. Se realizó un informe de caso con presentación inusual del cuadro clínico no causal, de una embarazada en su primer trimestre con sintomatología obstructiva, evolucionando a colangitis. se realizan exámenes de gabinete como ultrasonografía abdominal y exámenes de laboratorio revelando obstrucción, además de realizarse colangioresonancia y ultrasonografía endoscópica dando como resultado quiste de colédoco tipo 1C, se realiza drenaje. Posteriormente al alta hospitalaria, la paciente presenta nuevamente cuadro de colangitis, se realiza drenaje endoscópico, sin embargo, presenta aborto

Choledochal cysts are rare, in western countries an incidence of 1 per 100,000 live births has been reported. In Asian countries, this incidence is higher 1 per 100 live births. They are usually diagnosed during childhood and in 25 % of patients they present during their adult life. It is unusual for them to occur during pregnancy, especially during the first trimester. A case report was made with an unusual presentation of the non-causal clinical picture, of a pregnant woman in her first trimester with obstructive symptoms, evolving to cholangitis. Cabinet examinations such as abdominal ultrasonography are performed, resulting in type 1C common bile duct cyst. Drainage is performed After discharge from the hospital, the patient presents again with cholangitis, endoscopic drainage is performed, however, she has abortion

Guía de práctica clínica en dilatación congénita de las vías biliares en la edad pediátrica / Clinical practice guidelines in congenital dilation of biliary tract in pediatric ages

Las dilataciones congénitas de los conductos biliares, son poco frecuentes y se pueden descubrir en cualquier etapa de la vida, incluido el período prenatal. Es una afección que puede ser asintomáticas, ocasionar síntomas escasos o producir graves complicaciones, razones por las cuales, la actitud actual del especialista se enfoca hacia el diagnóstico temprano y el tratamiento correcto de las diferentes variantes de dilatación congénita de la vía biliar antes que aparezcan las complicaciones mencionadas. El objetivo de publicar esta guía responde a la necesidad de contar con herramientas actualizadas en el manejo de estas afecciones que permitan sistematizar la conducta y mejorar la calidad de la asistencia médica, la docencia y las investigaciones y está aprobada por la Sociedad Cubana de Cirugía Pediátrica. Se realizó una extensa revisión de la literatura científica basada en la mejor evidencia publicada mundialmente sobre el tema. Se presentan el concepto de esta afección, su epidemiología, clasificación, etiología, cuadro clínico, formas de presentación, diagnóstico y conducta a seguir con los diferentes tipos, así como las medidas posoperatorias y de seguimiento del paciente. Si todos los procedimientos se realizan de forma correcta y en el momento oportuno, el pronóstico es favorable en la mayoría de los casos(AU)

Congenital dilation in the biliary duct is not common and can be found in any stage of life, including the prenatal period. It is a condition that can be asymptomatic, causing scarse symptoms or producing severe complications; therefore, the current performance of specialists must be focused towards the early diagnosis and the accurate treatment of the different types of congenital dilation of the biliary tract before the above mentioned complications appear. The aim of publishing this guidelines has to do with the need of having updated tools for the management of these conditions which allow to systematize the behaviours and to improve the quality of medical care, teaching and researches, and also because it is approved by the Cuban Society of Pediatric Surgery. It was made an extensive review of the scientific literature based in the best evidences published worldwide on the topic. It is presented the concept of this condition, its epidemiology, classification, etiology, clinical picture, ways of presentation, diagnosis and behaviour to follow with the different types of it, as well as the patient's post-operative and follow-up measures. If all the procedures are made in a proper way and in the opportune moment, the prognosis is favorable in most of the cases(AU)

Coledococele: caso diagnosticado por resonancia magnética / Choledococele: case diagnosed by MRI

Resumen: El coledococele es una dilatación quística del segmento distal del conducto biliar común que sobresale en el lumen duodenal. Estos comprenden menos del 2% de todos los casos reportados de quistes de colédoco (2). Los hallazgos imagenológicos del coledococele y de los quistes de duplicación duodenal son muy similares, ambos presentan además clínica variada e inespecífica, por lo que el diagnóstico definitivo suele ser durante la cirugía. Presentamos un caso de una paciente de 10 años que consulta por dolor abdominal con elevación de transaminasas que, tras estudio con resonancia magnética con colangioresonancia y EDA se diagnostica coledococele.

Abstract: Choledochocele is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Is also known as type III choledochal cyst according to Todani's classification. It is usually misdiagnosed as duodenal duplication cyst. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiography for diagnosis of choledochocele. We present a case of a 10-years-old girl presented with abdominal pain, elevation of transaminases and a magnetic resonance cholangiopancreatography (MRCP) scan that revealed a choledochocele.

Choledochal cysts in children: How to Diagnose and Operate on

OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.

Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice / 中国当代儿科杂志

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.

Quiste de conducto cístico / Cystic duct cyst

Los quistes congénitos de la vía biliar son infrecuentes y se definen por la dilatación quística del árbol biliar en cualquiera de sus porciones. Los quistes del conducto cístico son aún menos frecuentes. Su etiología permanece incierta y el tratamiento consiste en la resección debido a su potencial desarrollo de malignidad. Presentamos el caso de una paciente en la que se diagnosticó dilatación del conducto cístico y fue tratada por vía laparoscópica.

Congenital biliary duct cysts are rare and are defined as cystic dilatations of the biliary tree in any of its portions. Cystic duct cysts are more uncommon. Their etiology remains uncertain and they should be resected due to the possible development of malignancy. We report the case of a female patient with a diagnosis of dilation of the cystic duct that was treated with laparoscopic surgery.

Minimally-invasive neonatal surgery: laparoscopic excision of choledochal cysts in neonates

PURPOSE: Improvements in surgical techniques and a better understanding of the unique anesthetic requirements in neonates undergoing laparoscopy have suggested that laparoscopic surgery may be effective in newborns. This study therefore evaluated the safety and feasibility of laparoscopic excision of the cyst (LEC) in neonates. METHODS: This retrospective study included 43 neonates who underwent excision of choledochal cysts between November, 2001, and January, 2018, including 21 who underwent open excision and 22 who underwent LEC. Their perioperative and surgical outcomes were reviewed. The patients were followed up for a median 37 months (range, 3–141 months). RESULTS: Baseline characteristics did not differ significantly in the open and LEC groups. Mean intraoperative peak partial pressure of arterial CO2 (PaCO2) (45.5 mmHg vs. 48.0 mmHg) and total operation time (208.3 ± 71.0 minutes vs. 235.0 ± 47.2 minutes) were similar in both groups. Parents of the patients in the LEC group provided a more positive evaluation of scar scale and greater satisfaction with wound. No patient in either group experienced any critical complications. Three patients in the open excision group required readmission for cholangitis and 2 patients had ileus. No patient in the laparoscopic excision group experienced any postoperative complications during follow-up. CONCLUSION: Despite difficulties performing laparoscopic surgery in neonates, LEC was safe and feasible when intraperitoneal peak pressure was maintained under 10 mmHg and PaCO₂ was closely monitored by a pediatric anesthesiologist. Compared with open excision, LEC provided improved cosmetic outcomes without severe complications. Prospective randomized studies with large numbers of patients are warranted.

A Rare Case of Extrahepatic Left Hepatic Duct Diverticulum: Case Report with Literature Review / 대한췌담도학회지

Hepatic duct diverticulum is a rare form of choledochal cyst that does not fit into the most widely used Todani classification system. Because of its rarity, it may be difficult for clinicians to diagnose and treat it. Here, we present a case of left hepatic diverticulum in a 57-year-old woman with epigastric pain. At presentation, there were mild elevations in the liver function tests. Computed tomography and magnetic resonance cholangiopancreatography showed diverticulum-like cystic lesion with sludge ball near the confluence portion of both intrahepatic bile duct, but the origin of the lesion could not be identified. The clinical impression was type II choledochal cyst. Surgical excision was planned due to recurrent abdominal pain. The operative findings revealed diverticulum arising from left hepatic duct. Histopathology confirmed the lesion to be diverticulum lined by biliary epithelium. The patient had no postoperative complication and no further symptoms since the operation.

Application of enhanced recovery after surgery in the treatment of children with congenital choledochal cyst / 浙江大学学报·医学版

OBJECTIVE@#To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst.@*METHODS@#One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (=65) and control group (=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups.@*RESULTS@#Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (<0.05 or <0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (<0.01), but the incidence of edema after operation was lower (<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (<0.05) and the total cost of hospitalization was reduced (<0.01).@*CONCLUSIONS@#ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.

Quiste gigante del colédoco en Pediatría / Giant bile duct cyst in Pediatrics

Introducción: los quistes del colédoco son infrecuentes en nuestro medio. Su etiología es desconocida, y su diagnóstico se realiza usualmente en los primeros años de vida. Presentación del caso: se reporta el caso de un niño de 5 años que presenta dolor abdominal de 6 meses de evolución, asociado a vómitos y masa abdominal. Conclusiones: los estudios imagenólogicos concluyen que se trata de quiste de colédoco tipo I(AU)

Introduction: bile duct cysts are uncommon in Pediatrics. Its etiology is unknown, and its diagnosis is usually made in the first years of life. Presentation of the case: the case of a 5-year-old boy with abdominal pain of 6 months' evolution, associated with vomiting and abdominal mass is reported. Conclusions: imaging studies conclude that it is a type I choledochal cyst(AU)

Management of Pediatric Patients Presenting with Acute Abdomen Accompanying Dilatation of the Common Bile Duct / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. METHODS: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. RESULTS: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was 6.4±4.9 (range, 0.8–17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. CONCLUSION: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

Choledochal cyst in the pediatric population: experience of 13 laparoscopic procedures in two years at a single institution / Cisto de colédoco na população pediátrica: experiência de 13 procedimentos laparoscópicos em dois anos de uma única instituição

ABSTRACT Objective: to describe the first 13 cases of laparoscopic correction of common bile duct cyst in the Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil. Methods: we performed a retrospective analysis of medical records of cases of choledochal cyst operated by laparoscopy between March 2014 and September 2016. Results: of the 13 patients, eight were female and the mean age at surgery was 7.8 years. The most common symptom was abdominal pain. The hepaticoduodenal anastomosis was the most used reconstruction technique, in 84.6% of the cases. There was no conversion to laparotomy or intraoperative complications. Only one patient presented anastomotic fistula and was reoperated by laparotomy. All patients were followed up in an outpatient clinic, were asymptomatic and had no episode of cholangitis after surgery, with a mean follow-up of 16 months. Conclusion: laparoscopy is a safe method to correct choledochal cysts, even in younger children, with low rates of complications and low rates of conversion to open surgery when performed by well trained surgeons.

RESUMO Objetivo: descrever os primeiros 13 casos de correção laparoscópica de cisto do ducto biliar comum no Hospital Pequeno Príncipe, Curitiba, Paraná, Brasil. Métodos: análise retrospectiva dos registros médicos em prontuário dos casos de cisto de colédoco operados por via laparoscópica entre março de 2014 e setembro de 2016. Resultados: dos 13 pacientes, oito eram do sexo feminino e a média de idade na ocasião da cirurgia foi de 7,8 anos. O sintoma mais comum foi dor abdominal. A anastomose hepático-duodenal foi a técnica de reconstrução mais utilizada, em 84,6% dos casos. Não houve conversão para laparotomia ou complicações intraoperatórias. Apenas um paciente apresentou fístula da anastomose e foi reoperado por laparotomia. Todos permanecem em acompanhamento ambulatorial, com tempo de seguimento médio de 16 meses, assintomáticos e não apresentaram episódio de colangite após a cirurgia. Conclusão: a laparoscopia é um método seguro para correção dos cistos de colédoco, mesmo em crianças mais jovens, com baixas taxas de complicações e baixas taxas de conversão para cirurgia aberta quando realizada por cirurgiões com bom treinamento.

A Case of an AUPBD Treated by Drainage of Major Papilla / 대한췌담도학회지

Anomalous union of the pancreaticobiliary duct (AUPBD) is a rare congenital anomaly, defined as the pancreaticobiliary ductal union located outside of the duodenal wall, usually forming a markedly long common channel. This anomaly is associated with congenital choledochal cyst, carcinoma of the biliary tract and pancreatitis, and is more commonly seen in Asian than in Western countries. AUPBD is frequently accompanied by biliary dilatation, but some patients with AUPBD have no biliary dilatation. The causal relationship between AUPBD and biliary dilatation associated with this anomaly has not been fully established. Here, we report a case of type IIIc2 AUPBD without biliary duct dilatation that was treated by drainage of major papilla.

Large Pancreatolith Formed in the Remnant Cyst after Incomplete Excision of Choledochal Cyst / 대한췌담도학회지

No abstract available.

Comparison of surgical outcomes of intracorporeal hepaticojejunostomy in the excision of choledochal cysts using laparoscopic versus robot techniques

PURPOSE: Increasing surgical expertise in minimally invasive surgery has allowed laparoscopic surgery to be performed in many abdominal surgeries. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy are challenging and sophisticated surgeries because of the difficult anastomosis. Recent advances in robotic surgery have enabled more delicate and precise movements, and Endowrist instruments allow for securing sutures during anastomosis. This study aimed to compare surgical outcomes of laparoscopic and robotic hepaticojejunostomy in choledochal cyst excision. METHODS: Sixty-seven patients who underwent laparoscopic or robotic-hybrid choledochal cyst excision from 2004 to 2016 were retrospectively analyzed and compared. In robotic surgery, dissection was performed laparoscopically, and hepaticojejunostomy was performed using a robotic platform. RESULTS: The mean operative time was significantly longer in robotic surgery than in laparoscopic surgery (247.94 ± 54.14 minutes vs. 181.31 ± 43.06 minutes, P < 0.05). The mean estimated blood loss (108.71 ± 15.53 mL vs. 172.78 ± 117.46 mL, respectively, P = 0.097) and postoperative hospital stay (7.33 ± 2.96 days vs. 6.22 ± 1.06 days, P = 0.128) were comparable between procedures. Compared to the laparoscopic approaches, robotic surgery had significantly less short-term complications (22.4% vs. 0%, P = 0.029). There were more biliary leakage (n = 7, 14.3%) observed during the first 30 days after surgery in laparoscopy while none were observed in the robotic method. CONCLUSION: Robotic surgery allow for more precise and secure sutures during anastomosis thereby reducing biliary complications. With expanding knowledge and expertise, robotic surgery may offer more advantages over laparoscopy in the era of minimally invasive surgery.

Resección y hepaticoyeyunostomía laparoscópicas en quiste de colédoco tipo 1 / Laparoscopic resection and hepaticojejunostomy for type 1 choledochal cyst

Los quistes del colédoco son dilataciones congénitas de la vía biliar que afectan fundamentalmente a la población pediátrica, de ellas, el tipo 1 es el más frecuente. Pueden producir graves complicaciones y el tratamiento quirúrgico de elección es la resección total de la lesión seguida de hepaticoenterostomía. Actualmente, este proceder se realiza por vía laparoscópica con buenos resultados. El objetivo del trabajo es reportar el tratamiento laparoscópico de un quiste de colédoco tipo 1 en un paciente de 5 años. No hubo complicaciones posoperatorias y los resultados estéticos y funcionales al año de seguimiento son excelentes. Se concluye que la resección laparoscópica en quistes de colédoco tipo 1 es posible y se sugiere continuar con su implementación(AU)

Choledochal cysts are congenital dilatation of the bile ducts that typically affect the pediatric population. Cases of its type 1 are the more frequent. Serious complications may occur and the surgical treatment of election is the lesions' total resection followed by hepaticoenterostomy. Today this procedure is carried out by laparoscopic way with good outcomes. The objective of this paper is to report a choledochal cyst type 1´s laparoscopic treatment in a 5-year-old patient. There were not postoperative complications and the aesthetic and functional results after one-year follow-up are excellent. The choledochal cysts´ laparoscopic resection is concluded to be possible and its implementation is suggested to follow(AU)

Caso Clínico: Quiste de Colédoco Tipo IA, Resolución Quirúrgica / Case Report: Type IA Choledochal Cyst, Surgical Resolution

INTRODUCCIÓN: El quiste del colédoco es una malformación congénita de etiología desconocida, caracterizada por diversos grados de dilatación del sistema biliar. El examen inicial para la valoración de la vía biliar debe ser una ecografía abdominal,sin embargo, la resonancia magnética con contraste es el estudio de elección para valorar estas estructuras. El tratamiento quirúrgico final depende del grado de dilatación quística y generalmente está basado en la escisión completa de la vía biliar extrahepática. CASO CLÍNICO: Paciente de sexo femenino de 27 años con dolor abdominal tipo cólico a nivel de epigastrio e hipocondrio derecho de 7 días de evolución. Se realizaron exámenes de Imagenología (ecografía­ TAC ­colangio RM)que reportaron colédoco con marcada dilatación fusiforme en toda su extensión, en relación a quiste de colédoco tipo IA. EVOLUCIÓN: Se planificó la exéresis del quiste de colédoco, anastomosis bilio-digestiva en «Y de Roux¼ y colecistectomía. El procedimiento quirúrgico no tuvo complicaciones. La paciente permaneció hospitalizada por 5 días con adecuada evolución y tolerancia a dieta. CONCLUSIÓN: El quiste de colédoco es una patología congénita infrecuente en la edad adulta generalmente diagnosticada como un hallazgo incidental. El diagnóstico y tratamiento oportuno aseguran el éxito del procedimiento quirúrgico y evita la aparición de complicaciones graves (colangiocarcinoma); con la escisión completa el pronóstico es excelente, la mortalidad posoperatoria es mínima. (au)

BACKGROUND: The choledochal cyst is a congenital malformation of unknown etiology characterized by different grades of dilatation of the biliary system. The first exam to evaluate the bile duct should be the abdominal ultrasound, which suggests the diagnosis of choledochal cyst. However, the magnetic resonance imagin with contrast is the gold standard to assess these structures. The final surgery treatment depends of the grade of cyst dilatation, the main procedure is based on the complete excision of the extrahepatic bile duct. CASE REPORT: A female 27-years old patient who reffered colic abdominal pain localized in epigastrium and right hypochondrium for 7 days. Imaging exams were performed (US­CT Scan­ choledochal MRI) which reported the bile duct with a severe fusiform dilatation, in complete extension related to type IA choledochal cyst. EVOLUTION: Choledocal cyst exeresis, «Roux-en-Y¼ bilio digestive anastomosis and cholecystectomy were planned. Surgical procedure had no complications. Patient was hospitalized for 5 days with proper evolution and oral diet tolerance. CONCLUSION: The choledochal cyst is a rare congenital disease in adult hood mostly diagnosed as an incidental finding. Early diagnosis and treatment ensure the success of the surgical procedure and prevents appearance of serious complications (cholangiocarcinoma).The prognosis after complete excision is excellent with minimal postoperative mortality(au)

Cisto de colédoco associado à adenocarcinoma de vesícula biliar / Colognic cisto associated with biliary vesicle adenocarcinoma

Os cistos de colédoco são dilatações congênitas dos ductos biliares, que podem ser extra-hepáticos e/ou intra-hepáticos. Mais prevalentes no sexo feminino e na maioria dos casos diagnosticados até a primeira década de vida. É uma entidade pouco frequente que, quando diagnosticada na população adulta, cursa com uma grande frequência de complicações, devendo-se estar atento em especial ao seu alto risco de malignização. Os autores descrevem o caso de uma paciente de 35 anos, do sexo feminino, que iniciou um quadro de dor abdominal inespecífica, sendo identificado um cisto de colédoco associado ao adenocarcinoma de vesícula biliar.

Choledochal cysts are congenital dilatation of the bile ducts, which can be extrahepatic or intrahepatic. They are more prevalent in women, and in most cases diagnosed until the first decade of life. They are a less common entity that, when diagnosed in the adult population, attends with a high frequency of complications, what makes important to be specially attentive to its high risk of malignant transformation. The authors describe the case of a 35 year-old female patient, who started an unspecific abdominal pain, being identified a choledochal cyst associated to a gallbladder adenocarcinoma.

Symptomatic Choledochal Cyst in Association with Pregnancy Managed with EUS-guided Choledochoduodenostomy without Fluoroscopic Guidance / 대한췌담도학회지

Choledochal cyst has only rarely been encountered in association with pregnancy. The clinical manifestations are nonspecific and variable that makes it difficult to differentiate from physiologic changes in pregnancy. Consequently, diagnosis is often delayed until patients present with life-threatening complications. During pregnancy, symptoms of choledochal cyst may be developed by hormonal changes and the enlarged uterus. Because of the risk of fetal mortality and maternal morbidity, definitive surgical treatment should be delayed and step-by-step management should be carefully implemented to avoid complication until delivery. Herein, we report a case of enlarged, symptomatic choledochal cyst that developed in a 26-year-old pregnant woman. The temporal relationship between pregnancy and symptom development, as well as the biliary sludge formation in the enlarged cyst, suggest that the choledochal cyst was influenced by pregnancy. In order to buy time for fetal maturation, endoscopic ultrasonography-guided choledochoduodenostomy was performed for biliary decompression as a bridge to surgical excision.