Reoperation of a patient with type <b>Ⅳ</b>a congenital choledochal cyst _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Ming ^1,2 , TAN Yifei ¹ ,  JIANG Li ¹ , YANG Jiayin ¹ , YAN Lünan ¹

1. Department of Liver Surgery/Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, Chengdu The Third People’s Hospital, Chengdu 610031, P. R. China;

Corresponding author：

JIANG Li, Email: jl339@126.com

Keywords：

type Ⅳa congenital choledochal cyst; choledochojejunostomy; hepatic lobectomy

DOI：

10.7507/1007-9424.201804014

Video：

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Objective To explore surgery strategy of reoperation for type Ⅳa congenital choledochal cyst. Methods The patient was a 20-year-old female with repeated right upper abdominal pain and fever for more than 1 year and aggravation for more than 1 month, and the choledochal cyst excison was performed 15 years ago. The MRI revealed that a huge cyst located in the left lobe of liver, with multiple intrahepatic calculus. The patient was diagnosed with a type Ⅳa congenital choledochal cyst and choledochojejunostomy later and the intrahepatic dilated bile duct was untreated. Results The cystic dilatation of the intrahepatic bile duct was confirmed during the reoperation, and the multiple stones with pus formation were seen, the color of the right liver was normal and the anatomical left hemihepatectomy was performed. The original anastomosis had no stenosis then was preserved. An about 1.5 cm length of extrahepatic bile duct was dissociated from the upper of anastomosis, and the extrahepatic bile duct was cut open and explored with a choledochoscope. The T-tube drainage was performed following removing the stone. The patient recovered well and was discharged smoothly following the surgery. The cholangiography 6 weeks later revealed that the biliary tract was patency and there was no residual stone. There was no jaundice or fever afterwards. Conclusion Complete excision of choledochal cyst and hepaticoduodenostomy is widely accepted as a standard surgery for type Ⅳa congenital choledochal cyst.

Citation： LI Ming, TAN Yifei, JIANG Li, YANG Jiayin, YAN Lünan. Reoperation of a patient with type Ⅳa congenital choledochal cyst . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(9): 1110-1114. doi: 10.7507/1007-9424.201804014 Copy

1.	Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg, 2009, 52(5): 434-440.
2.	He XD, Wang L, Liu W, et al. The risk of carcinogenesis in congenital choledochal cyst patients: an analysis of 214 cases. Ann Hepatol, 2014, 13(6): 819-826.
3.	Stain SC, Guthrie CR, Yellin AE, et al. Choledochal cyst in the adult. Ann Surg, 1995, 222(2): 128-133.
4.	Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg, 1977, 134(2): 263-269.
5.	Chaudhary A, Dhar P, Sachdev A. Reoperative surgery for choledochal cysts. Br J Surg, 1997, 84(6): 781-784.
6.	Alonso-lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg, 1959, 108(1): 1-30.
7.	Loke TK, Lam SH, Chan CS. Choledochal cyst: an unusual type of cystic dilatation of the cystic duct. AJR Am J Roentgenol, 1999, 173(3): 619-620.
8.	Michaelides M, Dimarelos V, Kostantinou D, et al. A new variant of Todani type Ⅰ choledochal cyst. Imaging evaluation. Hippokratia, 2011, 15(2): 174-177.
9.	Cho MJ, Hwang S, Lee YJ, et al. Surgical experience of 204 cases of adult choledochal cyst disease over 14 years. World J Surg, 2011, 35(5): 1094-1102.
10.	Baumann R, Uettwiller H, Duclos B, et al. Congenital cystic dilatation of the common bile duct, anomaly of the biliopancreatic junction and cancer of the bile ducts. Gastroenterol Clin Biol, 1987, 11(12): 849-855.
11.	Hamada Y, Ando H, Kamisawa T, et al. Diagnostic criteria for congenital biliary dilatation 2015. J Hepatobiliary Pancreat Sci, 2016, 23(6): 342-346.
12.	Cheung TT, Fan ST. Technical note on complete excision of choledochal cysts. Hepatobiliary Pancreat Dis Int, 2013, 12(2): 218-221.
13.	李刚, 徐智, 王立新, 等. 成人先天性胆总管囊肿的二次手术分析. 中国微创外科杂志, 2016, 16(8): 728-732.
14.	Xia HT, Dong JH, Yang T, et al. Selection of the surgical approach for reoperation of adult choledochal cysts. J Gastrointest Surg, 2015, 19(2): 290-297.
15.	周宁新, 谢于. 先天性胆管扩张症分型与术式选择. 中国实用外科杂志, 2012, 32(3): 191-192.
16.	Jabłońska B. Biliary cysts: etiology, diagnosis and management. World J Gastroenterol, 2012, 18(35): 4801-4810.
17.	Ohtsuka H, Fukase K, Yoshida H, et al. Long-term outcomes after extrahepatic excision of congenital choladocal cysts: 30 years of experience at a single center. Hepatogastroenterology, 2015, 62(137): 1-5.
18.	Tashiro S, Imaizumi T, Ohkawa H, et al. Pancreaticobiliary maljunction: retrospective and nationwide survey in Japan. J Hepatobiliary Pancreat Surg, 2003, 10(5): 345-351.
19.	Congo K, Lopes MF, Oliveira PH, et al. Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy. Ann Hepatol, 2012, 11(4): 536-543.
20.	Cerwenka H. Bile duct cyst in adults: interventional treatment, resection, or transplantation? World J Gastroenterol, 2013, 19(32): 5207-5211.
21.	Dutta HK. Hepatic lobectomy and mucosectomy of intrahepatic cyst for type Ⅳ-A choledochal cyst. J Pediatr Surg, 2012, 47(11): 2146-2150.
22.	夏中平, 闻久辉. 成人先天性胆总管囊肿35例手术体会. 肝胆胰外科杂志, 2017, 29(2): 154-156.
23.	Laukkarinen J, Chow P, Sand J, et al. Long-term changes in hepatobiliary physiology after Roux-en-Y hepaticojejunostomy. J Surg Res, 2007, 143(2): 270-275.
24.	刘厚宝, 沈盛. 胆肠吻合口狭窄主要原因及对策. 中国实用外科杂志, 2014, 34(10): 934-938.
25.	Hisakazu H. Surgery of the liver, biliary tract, and pancreas. 4th edition. 2-volume set. Shock, 2007: 28.
26.	Felder SI, Menon VG, Nissen NN, et al. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg, 2013, 148(3): 253-257.

1. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg, 2009, 52(5): 434-440.
2. He XD, Wang L, Liu W, et al. The risk of carcinogenesis in congenital choledochal cyst patients: an analysis of 214 cases. Ann Hepatol, 2014, 13(6): 819-826.
3. Stain SC, Guthrie CR, Yellin AE, et al. Choledochal cyst in the adult. Ann Surg, 1995, 222(2): 128-133.
4. Todani T, Watanabe Y, Narusue M, et al. Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg, 1977, 134(2): 263-269.
5. Chaudhary A, Dhar P, Sachdev A. Reoperative surgery for choledochal cysts. Br J Surg, 1997, 84(6): 781-784.
6. Alonso-lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int Abstr Surg, 1959, 108(1): 1-30.
7. Loke TK, Lam SH, Chan CS. Choledochal cyst: an unusual type of cystic dilatation of the cystic duct. AJR Am J Roentgenol, 1999, 173(3): 619-620.
8. Michaelides M, Dimarelos V, Kostantinou D, et al. A new variant of Todani type Ⅰ choledochal cyst. Imaging evaluation. Hippokratia, 2011, 15(2): 174-177.
9. Cho MJ, Hwang S, Lee YJ, et al. Surgical experience of 204 cases of adult choledochal cyst disease over 14 years. World J Surg, 2011, 35(5): 1094-1102.
10. Baumann R, Uettwiller H, Duclos B, et al. Congenital cystic dilatation of the common bile duct, anomaly of the biliopancreatic junction and cancer of the bile ducts. Gastroenterol Clin Biol, 1987, 11(12): 849-855.
11. Hamada Y, Ando H, Kamisawa T, et al. Diagnostic criteria for congenital biliary dilatation 2015. J Hepatobiliary Pancreat Sci, 2016, 23(6): 342-346.
12. Cheung TT, Fan ST. Technical note on complete excision of choledochal cysts. Hepatobiliary Pancreat Dis Int, 2013, 12(2): 218-221.
13. 李刚, 徐智, 王立新, 等. 成人先天性胆总管囊肿的二次手术分析. 中国微创外科杂志, 2016, 16(8): 728-732.
14. Xia HT, Dong JH, Yang T, et al. Selection of the surgical approach for reoperation of adult choledochal cysts. J Gastrointest Surg, 2015, 19(2): 290-297.
15. 周宁新, 谢于. 先天性胆管扩张症分型与术式选择. 中国实用外科杂志, 2012, 32(3): 191-192.
16. Jabłońska B. Biliary cysts: etiology, diagnosis and management. World J Gastroenterol, 2012, 18(35): 4801-4810.
17. Ohtsuka H, Fukase K, Yoshida H, et al. Long-term outcomes after extrahepatic excision of congenital choladocal cysts: 30 years of experience at a single center. Hepatogastroenterology, 2015, 62(137): 1-5.
18. Tashiro S, Imaizumi T, Ohkawa H, et al. Pancreaticobiliary maljunction: retrospective and nationwide survey in Japan. J Hepatobiliary Pancreat Surg, 2003, 10(5): 345-351.
19. Congo K, Lopes MF, Oliveira PH, et al. Outcomes of choledochal cysts with or without intrahepatic involvement in children after extrahepatic cyst excision and Roux-en-Y hepaticojejunostomy. Ann Hepatol, 2012, 11(4): 536-543.
20. Cerwenka H. Bile duct cyst in adults: interventional treatment, resection, or transplantation? World J Gastroenterol, 2013, 19(32): 5207-5211.
21. Dutta HK. Hepatic lobectomy and mucosectomy of intrahepatic cyst for type Ⅳ-A choledochal cyst. J Pediatr Surg, 2012, 47(11): 2146-2150.
22. 夏中平, 闻久辉. 成人先天性胆总管囊肿35例手术体会. 肝胆胰外科杂志, 2017, 29(2): 154-156.
23. Laukkarinen J, Chow P, Sand J, et al. Long-term changes in hepatobiliary physiology after Roux-en-Y hepaticojejunostomy. J Surg Res, 2007, 143(2): 270-275.
24. 刘厚宝, 沈盛. 胆肠吻合口狭窄主要原因及对策. 中国实用外科杂志, 2014, 34(10): 934-938.
25. Hisakazu H. Surgery of the liver, biliary tract, and pancreas. 4th edition. 2-volume set. Shock, 2007: 28.
26. Felder SI, Menon VG, Nissen NN, et al. Hepaticojejunostomy using short-limb Roux-en-Y reconstruction. JAMA Surg, 2013, 148(3): 253-257.

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Reoperation of a patient with type Ⅳa congenital choledochal cyst

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