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.
Similar content being viewed by others
References
Todani, T., Narusue, M., Watanabe, Y., Tabuchi, K., Okajima, K.: Management of choledochal cyst with intrahepatic involvement. Ann. Surg.187:212, 1978
Vater, A.: Dissertation in Auguralis. Medica Proes. Diss quascirrhis viscerum dissert c.s. exlerus.70:19, 1723
Alonso-Lej, F., Rever, W.B., Pessagno, D.J.: Collective review: Congenital choledochal cyst, with report of two and analysis of 94 cases. Int. Abstr. Surg.108:1, 1959
Okamura, K., Inoue, Y., Tsuji, K., Tashiro, S., Hiraoka, T.: Three cases of congenital dilatation of the biliary tract presented as cylindrical dilatation. Nippon Rinshogeka Igakkai Zasshi (Tokyo)44:71, 1983
Azuma, Y., Ishihara, M., Iwatani, I., et al.: Surgical therapy for congenital dilatation of biliary tract, especially concerning its untypical cylindrical dilatation. Syoni Geka (Tokyo)9:1161, 1977
Powell, S.C., Sawyers, J.L., Reynoldo, H.V.: Management of adult choledochal cysts. Ann. Surg.193:666, 1981
Komi, N., Udaka, H.: Congenital biliary dilatation—Comparison between pediatric cases and adult cases. Tan to Sui (Tokyo)3:327, 1982
Yotsuyanagi, S.: Contributions to the aetiology and pathogeny of idiopathic cystic dilatation of the common bile-duct with report of three cases. A new aetiological theory based on supposed unequal epithelial proliferation at the stage of the physiological epithelial occlusion of the primitive choledochus. G ANN30:601, 1936
Babbitt, D.P.: Congenital choledochal cysts. New etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb. Ann. Radiol.12:231, 1969
Shallow, T.A., Eger, S.A., Wagner, F.B., Jr.: Congenital cystic dilatation of the common bile duct. Ann. Surg.117:355, 1943
Ando, H.: Mechanism of bile duct dilatation in congenital dilatation of common bile duct. Nippon Geka Gakkai Zasshi (Tokyo)84:1174, 1983
Kinoshita, H., Nagata, E., Hirohashi, K., Sakai, K., Kobayashi, Y.: Carcinoma of the gallbladder with an anomalous connection between choledochus and the pancreatic duct. Report of ten cases and review of the literature in Japan. Cancer54:762, 1984
Irwin, S.T., Morison, J.E.: Congenital cyst of the common bile duct containing stones and undergoing cancerous change. Br. J. Surg.32:319, 1944
Hess, W.: Surgery of the Biliary Passages and the Pancreas. New York, D. Van Nostrand Co., Inc., 1965, pp. 33–42
Järvi, O., Laurén, P.: Intestinal metaplasia in the mucosa of the gallbladder and common bile duct. Ann. Med. Exp. Fenn.45:213, 1967
Laurén, P.: The two histological main types of gastric carcinoma. Diffuse and so-called intestinal type carcinoma. Acta Pathol. Microbiol. Scand.64:31, 1965
Matsumine, A.: Histogenesis of carcinoma of the gallbladder, with special reference to intestinal metaplasia of the cholecystic mucosa. Tan to Sui (Tokyo)2:1607, 1981
Hirai, S.: Clinicopathological study on metaplasia in resected gallbladder—As a background of histogenesis of gallbladder cancer. Nippon Syokakigeka Gakkai Zasshi (Tokyo)13:35, 1980
Komi, N., Tamura, T.: Intestinal metaplasia and malignant changes of the biliary tract caused by the anomalous arrangement disease of the pancreaticobiliary duct. Syonigeka (Tokyo)14:43, 1982
Tsuru, T.: Clinicopathological study on metaplasia in the bile duct mucosa with special reference to bile duct carcinoma. Nippon Geka Gakkai Zasshi85:482, 1984
Todani, T., Tabuchi, K., Watanabe, Y., Kobayashi, T.: Carcinoma arising in the wall of congenital bile duct cysts. Cancer44:1134, 1979
Flanigan, D.P.: Biliary cysts. Ann. Surg.182:635, 1975
Voyles, C.R., Smadja, C., Shands, W.C., Blumgart, L.H.: Carcinoma in choledochal cysts. Arch. Surg.118:986, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Issue Date:
DOI: https://doi.org/10.1007/BF01656096