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Inadvertent ligation of the main pancreatic duct: an extremely rare complication of choledochal cyst excision.

ABSTRACT: Pancreatic ductal injury is rare during choledochal cyst excision. Most cases present in the immediate postoperative period with pancreatic fistula or acute pancreatitis are managed conservatively. But, inadvertent ligation of the main pancreatic duct with subsequent recurrent pancreatitis and upstream dilatation of the pancreatic duct requiring a pancreatic ductal drainage operation has not been reported in the English literature. A 23-year-old female patient presented with recurrent episodes of upper abdominal pain for about 16 months. She had a history of type-1 choledochal cyst excision 18 months back. She was evaluated with abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP). MRCP showed hugely dilated main pancreatic duct with normal hepaticojejunostomy anastomosis. There was no residual cyst. MRCP findings were suggestive of stricture of the main pancreatic duct due to previous surgery. Endoscopic pancreatic ductal decompression failed. The patient was treated successfully with pancreaticogastrostomy. Postoperative recovery was uneventful. The patient was well at 24-month follow-up.

SUBMITTER: Ray S

PROVIDER: S-EPMC4425752 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Laparoscopic-assisted cyst excision and ductoplasty plus widened portoenterostomy for choledochal cysts with a narrow portal bile duct.

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Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy.

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Acquired choledochal cyst following intraabdominal tumor surgical excision: A case report.

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EUS diagnosis of asymptomatic type III choledochal cyst.

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The SHURUI single-port robotic system for choledochal cyst excision and biliary reconstruction in children: A case report (with video).

Project description:IntroductionTotal cyst excision and Roux-en-Y hepaticojejunostomy is the standard procedure for treating congenital choledochal cysts, which requires high surgical skills. Our aim is to introduce the experience with the SHURUI single-port robotic system in pediatric surgery.Presentation of caseIn this study, we present a case demonstrating the application of the SHURUI single-port robotic system in performing choledochal cyst excision and Roux-en-Y hepaticojejunostomy in a pediatric patients. Roux-en-Y anastomosis was constructed extracorporeally, then choledochal cyst excision and hepaticojejunostomy was performed intracorporally using the SHURUI Surgical System. Surgical complications and the wound outcomes were assessed. The total duration of the operation was 292 min, comprising an extracorporeal time of 45 min, docking time of 19 min, and intracorporal time of 183 min. The estimated blood loss was minimal at only 2 mL. The patient was discharged 6 days post-operation, and exhibited satisfactory recovery at the one-month follow-up.DiscussionThis case represents an initial experience with the SHURUI Surgical System in managing a pediatric choledochal cyst. The results indicate that the system is feasible and safe for this procedure, and may have some advantages over laparoscopic and open approaches.ConclusionThe SHURUI Surgical System is both feasible and safe in pediatric surgery, and it may offer certain advantages over laparoscopic and open approaches.

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Type VI choledochal cyst diagnosed on ERCP with direct cholangioscopy.

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Imaging diagnosis of a giant choledochal cyst in an infant.

Project description:The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary modality for diagnosis of this entity is ultrasound, followed by MRI. The characteristic ultrasound features of a choledochal cyst are a well-defined cystic lesion which may be found to replace any segment of the biliary tree and is distinctly separate from the gallbladder. The associated anomalies are biliary atresia, gallbladder atresia, hepatic fibrosis and those of the pancreatico-biliary ductal system. MRI with MRCP has a conclusive role in confirming the ultrasound diagnosis. Choledochal cysts are currently classified as proposed by Todani et al, into five types. Herein, we report the case study of a 4-month-old male infant afflicted with a gigantic, Type1 Choledochal cyst, complicated by perforation, which was diagnosed by us at the first instance itself, using ultrasound examination and confirmed by MRI. The diagnosis was further confirmed at surgery and histopathology. The recommended treatment of cyst resection accompanied by a hepatico-jejunostomy bypass procedure, was successfully performed in the reported infant.

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Type IV choledochal cyst with polycystic kidney disease: a case report.

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