Early complications after excision with hepaticoenterostomy for infants and children with choledochal cysts.
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OBJECTIVE: To retrospectively study the early complications of excision with hepaticoenterostomy for infants and children with choledochal cysts. METHODS: We analyzed 16 patients with early postoperative complications out of 173 patients with congenital choledochal cysts aged 27 days to 14 years (mean 2.4 years) who had undergone excisional procedures and biliary tract reconstruction. RESULTS: The early complications included bile leakage (10 patients), abdominal wall dehiscence (3), and hepatic failure, pancreatic juice leakage and postoperative intussusception (each in 1) respectively. Three patients died from bile leakage and 1 from postoperative hepatic failure. No statistical differences were observed between the procedures of biliary tract reconstruction with jejunal segment interposition hepaticoduodenostomy and Roux-en-Y hepaticojejunostomy (P>0.75). The morbidity was significantly higher in infants below 1 year than in children (P<0.005). Prevention and treatment of the complications were discussed. CONCLUSION: Bile leakage and abdominal wall dehiscence are major early postoperative complications. The morbidity of cholechal cysts is higher in infants than in children. Exploratory laparotomy should not be delayed when biliary leakage with diffuse peritonitis appears. The "tension suture in the fascial space of the abdominal wall" is useful to prevent and treat wound dehiscence. (+info)
Imaging diagnosis of pancreato-biliary diseases: a control study.
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AIM: To evaluate the clinical value of various imageological methods in diagnosing the pancreato-biliary diseases and to seek the optimal procedure. METHODS: Eighty-two cases of pancreato-biliary diseases confirmed by surgery and pathology were analyzed. There were 38 cases of cholelithiasis, 34 cases of pancreato-biliary tumors and 10 other cases. The imageological methods included B-US, CT, ERCP, PTC, cross-sectional MRI and MR cholangiopancreatography (MRCP). RESULTS: The accuracy rate of MRCP in detecting the location of pancreato-biliary obstruction was 100%. In differentiating malignant from benign obstruction, the sensitivity of the combination of MRCP and cross-sectional MRI was 82.3%, the specificity was 93.8%, and the accuracy rate was 89.0%. The accuracy rate for determining the nature of obstruction was 87.8%, which was superior to that of B-US (P=0.0000) and CT (P=0.0330), but there was no significant difference between direct cholangiopancreatography and the combination of MRCP and conventional MRI (P=0.6666). CONCLUSION: In most cases, MRCP can substitute direct cholangiopancreatography for diagnosis. The combination of MRCP and cross-sectional MRI should be considered as an important means in diagnosing the pancreato-biliary diseases, pre-operative assessment and post-operative follow-ups. (+info)
A retrospective study of choledochal cyst: clinical presentation, diagnosis and treatment.
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The treatment and early diagnosis of choledochal cyst are very important to prevent complications of the disease. Delay in treatment can cause lethal complications like biliary cirrhosis and increased morbidity in patients. We studied 26 children with choledochal cyst retrospectively for their clinical presentation, and for the diagnostic tools and treatment modalities, used. The most common findings of choledochal cyst in our series were abdominal pain, vomiting, and ictures in contrast to the classical triad of the disease of jaundice, mass and pain. The most useful diagnostic tool was abdominal ultrasonography. For the treatment, we preferred Roux-en-Y hepaticojejunostomy to the internal drainage procedures, and the results were excellent with minimal mortality and morbidity. We underline prompt diagnosis and treatment to prevent late complications of the disease. (+info)
Expressions of p53 and inducible nitric oxide synthase in congenital choledochal cysts.
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BACKGROUND: Choledochal cyst, an isolated defect unrestricted to the bile duct, is more appropriately regarded as the sentinel feature of a constellation of anomalies affecting the pancreatobiliary system. This study was to assess the relationship between the expression of inducible nitric oxide synthase (iNOS) and the p53 gene as well as the pathogenesis of choledochal cysts. METHODS: iNOS and p53 were detected by immunohistochemistry staining in 26 patients with congenital choledochal cysts. Histopathologically, hyperplasia of the mucosa of the cysts and the amylase level in the bile were also investigated. RESULTS: Patients with a high level of amylase in the bile had higher expression of iNOS than those with a low level of amylase. p53 protein was expressed neither in fusiform type nor in cystic type. The incidence of mucosal hyperplasia was significantly higher in the fusiform type than that in the cystic type. CONCLUSIONS: Higher expression of iNOS may participate in hyperplasia and carcinogenesis of the mucosa of choledochal cysts. The regurgitation of pancreatic juice into the biliary system might induce mucosal hyperplasia of the biliary tract and inflammatory reaction. In preventing regurgitation-caused hyperplasia and malignancy of the bi-liary tract, early surgery is important for children with congenital choledochal cysts. (+info)
Anomalous pancreaticobiliary junction: image analysis and treatment principles.
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BACKGROUND: Anomalous pancreaticobiliary junction is often associated with biliary tract carcinoma and acute pancreatitis. We assessed the value of image analysis in the diagnosis of patients with anomalous pancreaticobiliary junction (APBJ) and the principles for the treatment of APBJ. METHODS: Sixty-four patients with APBJ were subjected to ultrasound imaging, endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) before surgery. The diagnostic accuracy of image analysis and their surgical outcomes were evaluated retrospectively. RESULTS: On ERCP and MRCP, the length of the common channel was calculated to be 15 mm or longer in all patients, and the angle of the junction was more than 75 degree in 49 (76.6%) of the 64 patients. Of the 64 patients, 28 were defined of pancreatic duct type (P-C) (28/64, 43.75%), 32 bile duct type (C-P) (32/64, 50%), and 4 common channel type (4/64, 6.25%). CONCLUSIONS: Patients with APBJ are often associated with biliary tract and pancreatic diseases, and early detection and correct surgical treatment could avoid serious complications. ERCP and MRCP are accurate in the diagnosis of APBJ. (+info)
Different expression of cyclooxygenase-2 in biliary epithelia of bile duct cancer with or without pancreaticobiliary maljunction.
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BACKGROUND: Cyclooxygenase-2 (COX-2) has been reported to play an important role in the pathogenesis of a variety of cancers. Little is known about the relationship between bile duct cancer associated with pancreaticobiliary maljunction (PBM) and COX-2. MATERIALS AND METHODS: We compared the expression of COX-2 in bile duct epithelium in bile duct cancer with or without PBM. RESULTS: Immunohistochemical analysis showed that the rate of positive COX-2 expression was 42.9% for cancerous lesions and 7.1% for noncancerous lesions in cases of bile duct cancer without PBM. On the other hand, no positive expression of COX-2 was observed in cancerous lesion of bile duct cancer with PBM. Twenty % of the noncancerous bile duct mucosa with PBM was positive for COX-2. CONCLUSION: COX-2 is expressed in bile duct cancer while it is not expressed in bile duct cancer accompanied by PBM. (+info)
Choledochal cysts in pregnancy: case management and literature review.
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AIM: To evaluate the diagnosis, management principles and long-term results of congenital choledochal cysts in pregnancy. METHODS: Three adult patients were diagnosed as choledochal cysts in pregnancy from 1986 to 1989 and their long-term results were evaluated. RESULTS: The first patient had a Roux-en-Y cysto-jejunostomy with T-tube external drainage and died of septic shock and multi-organ failure 25 d after operation. In the second patient, 4 wk after percutaneous trans-choledochal cyst was drained externally with a catheter under US guidance, four weeks later the patient delivered vaginally, and had a cysto-jejunostomy 3 mo after delivery, and lived well without any complications for 15 years after operation. The third patient received Roux-en-Y cysto-jejunostomy after a vertex delivery by induced labor at 28 wk gestation, and demonstrated repetitively intermittent retrograde cholangitis within 10 years, and then died of well-differentiated congenital cholangioadenocarcinoma one month after re-operation with exploratory biopsy at the age of 36. CONCLUSION: More conservative approaches such as external drainage of choledochal cyst should be considered for pregnant patients with high risk, complete excision of choledochal cyst during hepaticojejunostomy or modified hepaticojejunostomy is highly recommended at the optimal time. (+info)
Experience of congenital choledochal cyst in adults:treatment, surgical procedures and clinical outcome in the Second Affiliated Hospital of Harbin Medical University.
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This study was undertaken to analyze and evaluate the diagnosis and principal treatment methods for congenital choledochal cyst, focusing on various surgical procedures and clinical outcome. A comprehensive, retrospective study was conducted on 72 adult patients who presented with choledochal cyst from 1985 to 2002. Surgical procedures were cyst excision with hepaticojejunostomy in 25 cases for type I or type IV-B, extrahepatic cyst excision with hepaticojejunostomy in 8 cases for type IV-A, extrahepatic cyst excision with modified hepaticojejunostomy in 2 cases for type IV-B, non-cyst excision with or without hepaticojejunostomy in 27 cases for types I, II, IV-A, IV-B. The early postoperative morbidity and mortality rate were 16.1% (9/62) and 6.5% (4/62) respectively, and the complication rate related to surgical procedure was 30.6% (19/62). The incidence of cholangiocarcinoma with non-cyst excision or non-operated congenital choledochal cyst was 10.8% (4/37). One patient died of primary hepatocellular carcinoma after cyst excision with hepatojejunostomy. In conclusion, our results showed that complete excision of choledochal cyst for types I, II, and IV-B and complete excision of extrahepatic choledochal cyst from the hepatic hilum in type IV-A with hepaticojejunostomy or modified hepaticojejunostomy are the treatment of choice for choledochal cyst in adult patients. (+info)