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Choledochal cyst: Complications of anomalous connection between the choledochus and pancreatic duct and carcinoma of the biliary tract

Abstract

We have done a retrospective study of the clinical features, complications, surgical treatment, histological findings, and outcome of 27 adults with choledochal cyst (congenital biliary dilatation) whom we have encountered in the past 11 years. In 24 (88.9%) of them, an anomalous connection between the choledochus and the pancreatic duct was found by direct cholangiography, or during operation or autopsy; three also had carcinoma of the biliary tract. In congenital biliary dilatation, this anomalous connection seems to be a major factor in causing cholangitis and carcinoma of the biliary tract. For this reason, congenital biliary dilatation must be treated surgically. This involves resection of the dilated bile duct and the gallbladder to remove the place where bile stasis had been present, and reconstruction of the biliary tract to stop reflux of pancreatic juice in the bile duct.

Résumé

Les auteurs se sont livrés à une étude rétrospective des caractères cliniques, des complications, du traitement chirurgical, des caractères histologiques et de l'évolution de 27 cas de kyste du cholédoque de l'adulte (dilatation biliaire congénitale) qu'ils ont eu à traiter au cours des 11 dernières années. Dans 24 de ces cas (88.9%) ils ont mis en évidence par la cholangiographie lors de l'opération ou à l'autopsie une connexion anormale entre le cholédoque et le canal pancréatique ainsi que 3 cancers biliaires. En cas de kyste du cholédoque cette anomalie paraît jouer un rôle fondamental dans le développement de l'angiocholite et du cancer biliaire. Pour cette raison le kyste du cholédoque doit être traité chirurgicalement ce qui signifie par la résection de la voie biliaire ectasiée et de la vésicule pour supprimer le lieu ou stagnait la bile, résection suivie de la reconstitution de la voie biliaire de façon à supprimer le reflux du suc pancréatique à son niveau.

Resumen

Hemos realizado un estudio sobre las características clínicas, complicaciones, tratamiento quirúrgico, hallazgos histológicos y resultado final en 27 adultos con quiste coledociano (dilatación biliar congénita) identificados en los últimos 11 años. En 24 (88.9%) de los pacientes se demostró una conexión anómala entre el colédoco y el canal pancreático por colangiografía directa, o en el curso de la operación o en la autopsia; tres pacientes también presentaron un carcinoma del tracto biliar. En los casos de dilatación biliar congénita tal conexión anómala parece ser un factor de importancia mayor en la causación de colangitis y de carcinoma del tracto biliar. Por esta razón la dilatación biliar congénita debe ser tratada quirúrgicamente. Esto significa la resección del canal biliar que está dilatado y de la vesícula biliar, con el fín de remover el lugar donde se produce la estasis biliar, así como la reconstrucción del tracto biliar con el propósito de controlar el reflujo de jugo pancreático.

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Correspondence to Eiichi Nagata M.D..

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Nagata, E., Sakai, K., Kinoshita, H. et al. Choledochal cyst: Complications of anomalous connection between the choledochus and pancreatic duct and carcinoma of the biliary tract. World J. Surg. 10, 102–108 (1986). https://doi.org/10.1007/BF01656096

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Keywords

  • Carcinoma
  • Bile Duct
  • Vascular Surgery
  • Thoracic Surgery
  • General Surgery