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Choledochal cyst: case report and literature review. Descritores: Ducto biliar comum. It is uncommon, having an estimated incidence of During physical examination the patient presented jaundice and a painless palpable mass in the right hypochondrium, having an approximate diameter of 25 cm, without any other alterations. Laboratory exams demonstrated an increase in canicular, hapatocytic and bilirubin enzymes.
CA , alfa-fetoprotein and CEA showed normal levels. Abdominal image exams revealed a cystic content mass in the choledochal and head of the pancreas. A choledochal cyst was revealed after laparotomy, being classified as type I, with regards to Todanis' classification. The gallbaldder was ressected jointly with the distal portion of the cyst. Biliodigestive anastomosis in Y of Roux was performed between the jejunum loop and distal portion of the cyst.
Postoperative evolution was tardied by bleeding from anastomosis and the patient was reoperated to contain bleeding and further complications. Diagnosis is easily done using image methods. However its treatment is difficult, sometimes being of great magnitude, therefore requiring individual treatment.
Negava acolia fecal, febre e emagrecimento. Pacientes adultos apresentam como sintoma mais comum dor abdominal - ausente no caso relatado. Congenital choledochal cysts, with report of 2, and an analysis of 94 cases.
Int Surg. Choledochal cysts in adults and their complications. HPB Surg ; Babbit DP. Congenital choledochal cysts:new etiological concept based on anomalous relantionships of the common bile duct and pancreatic bulb.
Ann Radiol Paris. Choledochal cysts-differences in children and adults. Br J Surg. Coelho JCU. Value of MR cholangiopancreatography in evaluating choledochal cysts. Congenital choledochal dilatation with emphasis on pathophysiology of the biliary tract.
Ann Surg. Nagorney DM. Bile duct cysts in adults. Surgery of the liver and biliary tract. London: WB Saunders: Choledochal cysts in western adults:complexities compared to children. J Gastrointest Surg ; Congenital bile duct cysts: classification, operative procedures, and rewiew of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg. Townsend CM. Sabiston - Tratado de cirurgia. Detection of reovirus RNA in hepatobiliary tissues from patients with extrahepatic biliary atresia and choledochal cysts.
Yamaguchi M. Congenital choledochal cyst. Analysis of patients in the Japanese literature. Am J Surg ; All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Headings: Common bile duct. Choledochal cyst. How to cite this article.
Mirizzi Syndrome Grades III and IV: Surgical Treatment
Objective: : to evaluate the epidemiology and outcomes of surgical treatment of patients with Mirizzi Syndrome MS grades III and IV, the most advanced according to Csendes classification. Methods: : we conducted a retrospective, cross-sectional study by reviewing records of thirteen patients with grades III and IV MS operated from December to September , among the 3, cholecystectomies performed in the period. Results: : the incidence of MS was 0. There was a predominance of type IV 12 cases. The preoperative diagnosis was possible in The preferred approach was biliary-digestive derivation 10 cases , and "T" tube drainage with suture of the bile duct was the choice in three special occasions. Three patients had biliary fistula resolved with clinical management, and one coliperitoneum case required reoperation.
Analysis of the modified side - to - side choledochoduodenostomy. Pacheco Jr. METHODS: Fourteen patients with a diagnosis of choledocholithiasis have been submitted to a side-to-side choledochoduodenostomy with a choledochal distal occlusion. Follow-up varied from three months up to ten years. These patients were evaluated for their clinical aspects under the Visick criteria. Blood screening tests for serum glutamicoxalacetic transaminases, serum glutamic-pyruvic transaminases, gama-GT, alkaline phosphatase and bilirubins were obtained.
Most biliary stone diseases need to be treated surgically. However, in special cases that traditional biliary tract endoscopic access is not allowed, a multidisciplinary approach using hybrid technique with urologic instrumental constitute a treatment option. We report a case of a patient with complex intrahepatic stones who previously underwent unsuccessful conventional approaches, and who symptoms resolved after treatment with hybrid technique using an endourologic technology. We conducted an extensive literature review until October of manuscripts indexed in PubMed on the treatment of complex gallstones with hybrid technique. The multidisciplinary approach with hybrid technique using endourologic instrumental represents a safe and effective treatment option for patients with complex biliary stone who cannot conduct treatment with conventional methods.