Intrahepatic Class VII Choledochal Cyst: Radiological Insights and Surgical Approach.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Thamer H Alghamdi
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引用次数: 0

Abstract

BACKGROUND Choledochal cysts are congenital cystic dilatation of any section of the bile ducts. They have been divided into 5 primary categories. This is the case of an intrahepatic variant of bile duct cysts originating from the main lobar bile ducts at the confluence, initially radiologically identified as biliary cystadenoma in segments 4b and 5. CASE REPORT A 35-year-old woman presented with right upper quadrant pain and palpable mass during examination. History and laboratory results were normal. Magnetic resonance cholangiopancreatography revealed a complicated cystic lesion compressing right and left proximal hepatic ducts, diagnosed radiologically as biliary cyst adenoma in segments 4b and 5. Intraoperatively, large cyst found in liver segment 4b and 5, extending infra-hepatic, included the confluence of the common hepatic duct and extended to the gallbladder. It was easily separable from the gallbladder, and total cholecystectomy was done; however, the cyst was inseparable from the confluence of common hepatic duct. The peritoneum over the cyst, containing the right and left hepatic duct and in the area of confluence, was dissected and pushed down to avoid injury; enucleation of the lower border was successfully done. Upper border was transected through liver parenchyma; many small ductules connected with the cyst were ligated. Resection should be done to decrease possibility of malignant transformation and prevent recurrent cholangitis. CONCLUSIONS Class VII choledochal cyst is rare, and surgery is the preferred choice, after proper evaluation of the cyst and surrounding structure. Magnetic resonance cholangiopancreatography still has a high overall accuracy for choledochal cyst diagnosis and classification.

肝内VII类胆总管囊肿:影像学观察和手术入路。
背景:胆总管囊肿是先天性胆管任何部分的囊性扩张。它们被分为5个主要类别。肝内变型胆管囊肿起源于大叶胆管汇合处,最初放射学鉴定为4b和5节段胆道囊腺瘤。病例报告一名35岁女性,在检查时表现为右上腹疼痛和可触及的肿块。病史和化验结果正常。磁共振胆管造影显示一复杂的囊性病变压迫左右近端肝管,影像学诊断为4b段和5段胆道囊肿腺瘤。术中发现肝4b、5段大囊肿,向肝下延伸,包括肝总管汇合处,并延伸至胆囊。易与胆囊分离,行全胆囊切除术;但囊肿与肝总管汇合处分不开。将包涵左、右肝管及汇合处的囊肿上方腹膜切开并下推,避免损伤;下缘摘除术成功。通过肝实质横切上缘;许多与囊肿相连的小管被结扎。切除以减少恶性转化的可能性,防止复发胆管炎。结论7级胆总管囊肿罕见,在对囊肿及周围结构进行合理评估后,手术治疗是首选。磁共振胆管造影对胆总管囊肿的诊断和分类仍具有较高的总体准确性。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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