Intraductal Papillary Mucinous Neoplasm with Associated Invasive Carcinoma Arising from Remnant Cystic Duct: A Case Report

Intraductal papillary mucinous neoplasm (IPMN) involving the biliary system is rare. To date, only a few cases of IPMN arising from the extrahepatic bile duct have been reported. In our case, extrahepatic IPMN arose in the remnant cystic duct after cholecystectomy, and to the best of our knowledge, this is the first report in the remnant cystic duct after cholecystectomy. A 74-year-old woman was referred for right upper quadrant pain lasting one day. Ultrasonography (US) showed a lobulated and hyperechoic mass with an outer linear hypoechoic lesion located adjacent to the dilated common bile duct. Contrast enhanced computed tomography showed a heterogeneously enhancing mass. Magnetic resonance imaging (MRI) showed a heterogenous mass with an outer semicircular high signal portion indicating remnant cystic duct.

Clinical significance of preoperative magnetic resonance cholangiopancreatography in the evaluation of anatomic variants of the extrahepatic biliary tract / 中华消化外科杂志

Objective To evaluate the feasibility and clinical significance of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of anatomic variants of the extrahepatic biliary tract. Methods The MRCP images of 535 patients who were admitted to The Second Affiliated Hospital of Suzhou University from March 2008 to March 2009 were retrospectively analyzed by two reviewers independently. The anatomic variants of the extrahepatic biliary tract were evaluated by studying the T2-weighted magnetic resonance images. Results The consistency between the two reviewers in the diagnosis of low choledochal joint, medial cystic duct insertion, aberrant hepatic duct, accessory hepatic duct and other anatomic variants was 98% , 99% , 89% , 90% and 100%, respectively (K = 0.86, 0.93, 0.81, 0.82, 1.00). The extrahepatic biliary system was clearly displayed by MRCP in 500 patients, and anatomic variants were observed in 240 patients, including low choledochal joint in 85, parallel cystic duct in 37, medial cystic duct insertion in 82, aberrant hepatic duct in nine, accessory hepatic duct in 10, choledochal cyst in three and high cystic duct in seven. A total of 259 patients underwent operation, and 168 patients had anatomic variants of the extrahepatic biliary tract. Conclusion MRCP imaging enables the accurate assessment of anatomic variants of the extrahepatic biliary system and avoids bile duct injury.

Atresia of the extrahepatic biliary system (a report and review)

A case report of a complete atresia of the extra hepatic biliary system is made and a brief review of the many aspects involved in the management of the case is given. An early diagnosis should be the objective as early as possible during the first six months of life, if we are to offer a chance of salvage to the newborn. Unfortunately, it is not always so attained. A dilemma in the diagnosis arises such that an early diagnostic laparotomy is indicated. (Summary)

Blood supply and clinical significance of extra hepatic duct / 中华器官移植杂志

Objective To observe the blood supply of the extra hepatic duct and prevent the ischemia of extra hepatic duct after liver transplantation. Methods Microdissection for the main arteries of extra hepatic duct in 15 samples was performed. Results The main arteries supplying extra hepatic duct included cystic artery’s branches and posterior superior pancreaticoduodenal artery’s branches. There were 1~3 cystic artery’s branches and 3~5 posterior superior pancreaticoduodenal artery’s branches to supply extra hepatic duct. Conclusion The posterior superior pancreaticoduodenal artery is one of the main arteries supplying extra hepatic duct. In orthotopic liver transplantation, this artery is considered to preserve.