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Persistent biliary dilatation and stenosis in postoperative congenital choledochal cyst

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

Cholangitis and intrahepatic stones occur long after total cyst excision in patients with congenital choledochal cyst (CCC). Our study aimed to characterize morphological features of intrahepatic biliary dilatation and stenosis before and after total cyst excision, based on long-term follow-up data.

Methods

Pre- and postoperative morphological features of intrahepatic biliary dilatation were determined in 63 patients with CCC.

Results

Postoperatively, hepatic ductal dilatation persisted in 50 patients and hepatic ductal dilatation with stenosis in 35 patients. Hepatic duct stenosis was seen in 35 patients: unilateral hepatic duct stenosis in 21, and bilateral stenosis in 14. Stenosis at the confluence of the right and left hepatic ducts occurred more often in the cystic type of dilatation than in the cylindrical type and was seen more often on the left side than the right. Cases with postoperative cholangitis or intrahepatic stones featured stenosis at the confluence of left and both hepatic ducts (n = 2); and alternating dilatation and stenosis of left hepatic ducts and branches (n = 3). However, no statistical associations were observed between the hepatic ductal stenosis and cholangitis or stone formation (P = 0.153).

Conclusions

Cystic-type biliary dilatations persist postoperatively, frequently accompanied by ductal stenosis. Alternating dilatation and stenosis is a common morphological feature for postoperative cholangitis and stones.

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References

  1. Todani T, Watanabe Y, Toki A, Morotomi Y. Classification of congenital biliary cystic disease: special reference to type Ic and IVA cysts with primary ductal stricture. J Hepatobiliary Pancreat Surg. 2003;10:340–4.

    Article  PubMed  Google Scholar 

  2. Tsuchida Y, Ishida M. Dilatation of the intrahepatic bile ducts in congenital cystic dilatation of the common bile duct. Surgery (St. Louis). 1971;69:776–81.

    CAS  Google Scholar 

  3. Todani T, Narusue M, Watanabe Y, Tabuchi K, Okajima K. Management of congenital choledochal cyst with intrahepatic involvement. Ann Surg. 1978;187:272–80.

    Article  CAS  PubMed  Google Scholar 

  4. Lipsett PA, Pitt HA, Colombani PM, Boitnott JK, Cameron JL. Choledochal cyst disease. A changing pattern of presentation. Ann Surg. 1994;220:644–52.

    Article  CAS  PubMed  Google Scholar 

  5. Chijiiwa K, Komura M, Kameoka N. Postoperative follow-up of patients with type IVA choledochal cysts after excision of extrahepatic cyst. J Am Coll Surg. 1994;179:641–5.

    CAS  PubMed  Google Scholar 

  6. Koshinaga T, Fukuzawa M. Treatment of pancreaticobiliary maljunction: hepatic complications and intrahepatic biliary structure in Todani’s type IV A congenital choledochal cyst. In: Koyanagi Y, Aoki T, editors. Pancreaticobiliary maljunction. Tokyo: Igaku Tosho Shuppan; 2002. p. 347–52.

  7. Kawarada Y, Das BC, Tabata M, Isaji S. Surgical treatment of type IV choledochal cysts. J Hepatobiliary Pancreat Surg. 2009;16:684–7.

    Article  PubMed  Google Scholar 

  8. Matsumoto Y, Fujii H, Yoshioka M, Sekikawa T, Wada T, Yamamoto M, et al. Biliary strictures as a cause of primary intrahepatic bile duct stones. World J Surg. 1986;10:867–75.

    Article  CAS  PubMed  Google Scholar 

  9. Todani T, Watanabe Y, Toki A, Ogura K, Wang ZQ. Co-existing biliary anomalies and anatomical variants in choledochal cyst. Br J Surg. 1998;85:760–3.

    Article  CAS  PubMed  Google Scholar 

  10. Lenriot JP, Gigot JF, Segol P, Fagniez PL, Fingerhut A, Adloff M. Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research. Ann Surg. 1998;228:159–66.

    Article  CAS  PubMed  Google Scholar 

  11. Uno K, Tsuchida Y, Kawarasaki H, Ohmiya H, Honna T. Development of intrahepatic cholelithiasis long after primary excision of choledochal cysts. J Am Coll Surg. 1996;183:583–8.

    CAS  PubMed  Google Scholar 

  12. Maki T. Pathogenesis of calcium bilirubinate gallstone: role of E. coli, beta-glucuronidase and coagulation by inorganic ions, polyelectrolytes and agitation. Ann Surg. 1966;164:90–100.

    Article  CAS  PubMed  Google Scholar 

  13. Kaneko K, Ando H, Seo T, Ono Y, Ochiai K, Ogura Y. Bile infection contributes to intrahepatic calculi formation after excision of choledochal cysts. Pediatr Surg Int. 2005;21:8–11.

    Article  PubMed  Google Scholar 

  14. Miyano T, Yamataka A, Kato Y, Kohno S, Fujiwara T. Choledochal cysts: special emphasis on the usefulness of intraoperative endoscopy. J Pediatr Surg. 1995;30:482–4.

    Article  CAS  PubMed  Google Scholar 

  15. Ando H, Kaneko K, Ito F, Seo T, Ito T. Operative treatment of congenital stenoses of the intrahepatic bile ducts in patients with choledochal cysts. Am J Surg. 1997;173:491–4.

    Article  CAS  PubMed  Google Scholar 

  16. Tsuchida Y, Taniguchi F, Nakahara S, Uno K, Kawarasaki H, Inoue Y, et al. Excision of a choledochal cyst and simultaneous hepatic lateral segmentectomy. Pediatr Surg Int. 1996;11:496–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Tsugumichi Koshinaga, Mikiya Inoue, Kensuke Ohashi, Kiminobu Sugito, Tarou Ikeda, Noritsugu Hagiwara & Ryouichi Tomita

Authors
  1. Tsugumichi Koshinaga
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  2. Mikiya Inoue
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  3. Kensuke Ohashi
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  4. Kiminobu Sugito
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  5. Tarou Ikeda
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  6. Noritsugu Hagiwara
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  7. Ryouichi Tomita
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Correspondence to Tsugumichi Koshinaga.

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Koshinaga, T., Inoue, M., Ohashi, K. et al. Persistent biliary dilatation and stenosis in postoperative congenital choledochal cyst. J Hepatobiliary Pancreat Sci 18, 47–52 (2011). https://doi.org/10.1007/s00534-010-0294-0

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  • DOI: https://doi.org/10.1007/s00534-010-0294-0

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