Presentation
A changing pattern of presentation. Ann Surg 220: 644-652. [omicsonline.org]
PubMed Google Scholar We present a case of EUS-guided diagnosis of a type IIIA choledochal cyst. [videogie.org]
[…] modality for patients presenting with signs and symptoms of an acute or subacute biliary abnormality. [appliedradiology.com]
Patients with this condition present with biliary colic, cholangitis, or pancreatitis.12 Until recently, transduodenal cyst excision with or without sphincterotomy had been the treatment of choice.3 At present, however, endoscopic sphincterotomy and cyst [e-ce.org]
They have a female predominance and are the most likely to present at an older age. The most common clinical presentation is acute pancreatitis. The overall incidence of adenocarcinoma is approximately 2.5%. [giejournal.org]
Entire Body System
- Fever
The classical clinical symptoms are abdominal pain, jaundice and fever in a pre-school children8. Nevertheless, it may be present in adults in 20%8. [scielo.br]
On the physical examination there was no sign of fever or jaundice. The abdomen was tender to deep palpation at the right upper quadrant. Neither rebound tenderness nor distention was noted. [eurorad.org]
Discussion and conclusion Most patients with type III CCs complain of abdominal pain, followed by nausea/vomiting, fever, or jaundice [4, 5]. [bmcsurg.biomedcentral.com]
The patient followed a favorable fast outcome with the disappearance of the fever and the jaundice. Obviously surgical treatment was rejected. [scielo.isciii.es]
She denied any episodes of fever or chills, nausea and vomiting or recent weight loss. There was no significant medical history. [dovepress.com]
- Sepsis
Apart from this, it requires sedation, and there are risks of complications such as biliary sepsis, cholangitis, pancreatitis, perforation, and contrast allergy. [ejrnm.springeropen.com]
The outcome was poor; the patient presented abdominal sepsis, septic shock and disseminated intravascular coagulation, and died on the 21st postoperative day.Case 3 A 22 year-old primiparous patient, with no relevant history. [elsevier.es]
The current approach to CCD involves control of biliary sepsis and pancreatitis and defining both the superior and inferior extent of the cyst, before scheduling surgery in semielective setting [2–7]. [hindawi.com]
- Pathologist
The histology results were received two weeks after surgery, which is not unusual in our setting due to histopathology backlogs and scarcity of pathologists. [dovepress.com]
[…] developing malignancy.[36] [Level 3] To achieve the best results in the care and management of patients with choledochal cysts, it is important to form an interprofessional group of specialists including pediatric surgeons, pediatric gastroenterologists, pathologists [statpearls.com]
Cardiovascular
- Thrombosis
Potential postoperative complications include rejection and vascular thrombosis. Pre-transplant workup of these patients for occult cholangiocarcinoma is crucial.24 Minimally invasive resection of CC has gained popularity. [elsevier.es]
Neurologic
- Irritability
She had a history of mixed-type irritable bowel syndrome but reported worsening constipation with abdominal cramping localized to the lower abdomen. She underwent a colonoscopy that was remarkable for severe diverticulosis in the sigmoid. [videogie.org]
On physical examination the patient was found to be conscious, cooperative and calm, jaundice +++, soft abdomen, rounded due to adipose panniculus and gravid uterus, with mild pain on deep palpation, with no signs of peritoneal irritation. [elsevier.es]
Workup
See Workup for more detail. [emedicine.medscape.com]
Further workup with a multidisciplinary team led to the correct diagnosis and management. [jmedicalcasereports.biomedcentral.com]
The patient's biliary obstructive symptoms allowed for a targeted workup and rapid identification of her choledochal cyst, a diagnosis which can often be delayed due to vague presenting symptoms.21 Fortunately, her cyst was able to be treated before the [facs.org]
Pre-transplant workup of these patients for occult cholangiocarcinoma is crucial.24 Minimally invasive resection of CC has gained popularity. [elsevier.es]
Clinical presentation, laboratory workups, and intraoperative findings in this case also pointed towards CC-related complications which are sometimes the only presenting feature especially in the adult population. [eglj.springeropen.com]
Treatment
Endoscopic unroofing may be considered as a simple and safe treatment option for choledochocele. [e-ce.org]
Diagnosis and minimally invasive treatment of type III choledochal cysts. [bmcsurg.biomedcentral.com]
Endoscopic drainage of choledococele was a good option for conservative treatment. [scielo.br]
An algorithm based on patient age, cyst size, lining and amenability to endoscopic resection may be considered as a treatment strategy for this uncommon condition. [pubmed.ncbi.nlm.nih.gov]
guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine Restriction This video is limited to doctors and other health professionals. [medtube.net]
Prognosis
Does the type of anomalous arrangement of pancreaticobiliary ducts influence the surgery and prognosis of choledochal cyst? J Pediatr Surg. 1992;27(6):728-31. Alonso-Lej F, Rever WB Jr, Pessagno DJ. [ijmedicine.com]
Treatment and prognosis Patients with type I, II, or IV cysts usually undergo surgical resection of the cyst due to the risk of malignancy. A number of possible approaches exist, depending on cyst location and other factors. [radiopaedia.org]
Hence early diagnosis and appropriate management are needed for the best prognosis. [statpearls.com]
Approximately 67% of patients present with signs or symptoms referable to the cyst before the age of 10 years. [11] Prognosis The prognosis after excision of a choledochal cyst is usually excellent, but it is influenced by several factors, including patient's [emedicine.medscape.com]
[…] include cholecystitis, recurrent cholangitis, biliary stricture, choledocholithiasis, recurrent acute pancreatitis, and malignant transformation into cholangiocarcinoma.16,17 When occurring alone, the single umbilical artery has little effect on infant prognosis [dovepress.com]
Etiology
Various theories have been put forth to explain the etiology of choledochal cysts. [appliedradiology.com]
Its precise etiology is not clear 3. Patients are usually adolescents and may present with a recurrent crisis of right upper quadrant pain, hyperamylasemia, or jaundice. Malignant transformation of a choledochocele occurs very rarely. [radiopaedia.org]
Its precise etiology is not clear. Patients are usually adolescents and may present with a recurrent crisis of right upper quadrant pain, hyperamylasemia, or jaundice. Malignant transformation of a choledochocele occurs very rarely. [devel.pacs.de]
The etiology of choledochal cysts is not completely understood, but various mechanisms for development have been proposed. [facs.org]
Case Report The patient is a 20-year-old male with a history of episodes of acute pancreatitis of undetermined etiology that had been treated in primary care clinics, as well as several episodes of jaundice. [elsevier.es]
Epidemiology
[…] curid=2309266 Epidemiology Although choledochal cysts are present at birth, they are increasingly diagnosed in adults and now comprise 20% of all new cases. Choledochal cysts are inflammatory in nature. [surgery.ucsf.edu]
Epidemiology, presentation, diagnosis, and outcomes of choledochal cysts in adults in an urban environment. Am J Surg, 189 (2005), pp. 527-531 [5] T. Kamisawa, H. Anjiki, N. Egawa, M. Kurata, G. Honda, K. Tsuruta. [elsevier.es]
Choledochal Cysts in Children: Epidemiology and Outcomes. World J Surg 2008; 32:1385-1388. Chen H, Jan Y, Chen M. Surgical treatment of choledochal cyst in adults: results and long-term follow-up. Hepatogastroenterology 1996 43:1492-1499. [sapd.es]
Clinical-epidemiological analysis of a large consecutive series of malformed infants. Am J Med Genet A. 2008;146A(1):15–25. 5. Rittler M, Mazzitelli N, Fuksman R, de Rosa LG, Grandi C. [dovepress.com]
Caroli disease is associated with biliary atresia since it might share the same pathogenesis of ductal plate malformation, but is also associated with autosomal recessive polycystic kidney disease (PKD) and less frequently with autosomal dominant PKD.[9] Epidemiology [statpearls.com]
Pathophysiology
DISCUSSION The pathophysiology of choledochal cysts starts with a developmental anomaly, a pancreaticobiliary maljunction 1 leading to pancreatic reflux into the biliary tree3,10.The pancreatobiliary reflux normally is followed by a wall weakening and [scielo.br]
Pathophysiology No strong unifying etiologic theory exists for choledochal cysts. [emedicine.medscape.com]
Surgery. 2004 Apr; [PubMed PMID: 15041974] [6] Okada A,Hasegawa T,Oguchi Y,Nakamura T, Recent advances in pathophysiology and surgical treatment of congenital dilatation of the bile duct. [statpearls.com]
Iwai NYanagihara JTokiwa KShimotake TNakamura K Congenital choledochal dilatation with emphasis on pathophysiology of the biliary tract. Ann Surg. 1992;21527- 30Google ScholarCrossref 13. [jamanetwork.com]
The second theory known as Babbitt’s hypothesis is based on the pathophysiological consequence of reflux of activated proteolytic pancreatic enzymes on the biliary tract wall [18]. [hindawi.com]
Prevention
Conclusion Isolated dilatations of the cystic duct are extremely rare, and familiarity with this anatomic variation and its early diagnosis can prevent complications such as inflammation and malignancy and guide the surgery. [ejrnm.springeropen.com]
To prevent cyst recurrence, cancer of postoperative residual bile duct, and reoperation occurrence, the excision range is rational and appropriate but slightly radical. [journals.lww.com]
In spite of their rarity, CCs are important to study since they must be recognized and treated according to their symptoms to prevent biliary malignancies [2, 3]. [bmcsurg.biomedcentral.com]
Complete surgical resection of giant choledochal cysts is surgically challenging, but essential to relieve symptoms and prevent malignant transformation. [dovepress.com]