RESUMO
OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.
Assuntos
Ductos Biliares/diagnóstico por imagem , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/cirurgia , Criança , Cisto do Colédoco/classificação , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.
Assuntos
Humanos , Criança , Ductos Biliares/diagnóstico por imagem , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Cisto do Colédoco/diagnóstico , Complicações Pós-Operatórias , Cisto do Colédoco/classificação , Estudos Retrospectivos , Ultrassonografia , Resultado do TratamentoRESUMO
El quiste del colédoco es una rara anomalia congénita que ocurre en los países occidentales con una frecuencia de 1 por cada 2 millones de nacidos vivos. De predominio en el sexo femenino en una relación 4:1. La colangiografia permite clasificarlos en cinco tipos anatómicos y de acuerdo a la unión pancreático biliar en seis tipos. Su etiología no está todavía bien definida. Entre las hipótesis que tratan de explicar su patología están la debilidad de la pared del conducto biliar, la obstrucción distal del colédoco y el reflujo de enzimas pancreáticas al conducto biliar principal. En este informe se presentan quince casos tratados con éxito en el servicio de cirugía ifantil del Hopsital Unversitario de Maracaibo entre 1988 y 2008, todos del tipo 1 en hembras, con un poco más de la mitad entre 1 y 5 años de edad. En 14 casos se practicó la extirpación total con anastomosis hepato-yeyunal en "Y" de Roux y extirpación parcial en uno. Todos sobrevivieron. Entre las complicaciones se citan una dehiscencia de la anastomosis y una eventración posoperatoria en el mismo paciente.
Choledochal cysts are a rare congenital anomaly in occidental countries with a frequences of 1 x 2 million of live births. Predominant in females with a relation 4:1. By colangiography they are classify in five types and according to the pancreatic bile union in six types. Aetiology is still unknown. Among the hypothesis to explain pathogeny we have weak bile un conduct wall, distal choledochal obstruction and pancreatic enzymes reflux into the principal bile duct. In his report we present 15 treated cases with success between 1988 and 2008 in the surgical service for children of the Maracaibo university hospital, all of them type I in female patients with a little more tham half between I and 5 years old. In 14 cases we practice total extirpation with hepato-yeyunal anastomosis in Roux "Y" and partial extirpation in one. All of them survive. As complications they were one anastomosis dehiscence and one postoperative eventration in the same patient.
Assuntos
Humanos , Feminino , Lactente , Pré-Escolar , Ducto Colédoco/cirurgia , Ducto Colédoco/patologia , Cisto do Colédoco/cirurgia , Cisto do Colédoco/classificação , Cisto do Colédoco/genética , Ultrassonografia , Anastomose em-Y de Roux/métodos , Colangiografia/métodosRESUMO
Clasificación de los quistes, etiología, diagnóstico y tratamiento. En el caso que se presenta se diagnosticó un quiste Tipo Ic en la semana 29 de gestación, y se confirmó el diagnóstico luego de una cesárea de urgencia en la semana 40.
Assuntos
Feminino , Gravidez , Humanos , Cisto do Colédoco/classificação , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/etiologia , Cisto do Colédoco , Ultrassonografia Pré-NatalRESUMO
El quiste de colédoco consiste en la dilatación quística de la vía biliar intrahepática o extrahepática. Según la teoría mas aceptada, es causado por una anormalidad de la unión biliopancreática. Sus complicaciones más importantes son colangiocarcinoma, litiasis biliar, y pancreatitis, y su terapia es la resección quirúrgica. Sólo 20 por ciento a 30 por ciento de los casos se diagnostican en la vida adulta. Se reportan dos casos de quiste de colédoco en pacientes femeninas adultas, una de ellas al final de la gestación, y la otra puérpera. El diagnóstico de quiste de colédoco en la gestación y puerperio es un evento inusual que tiene consideraciones propias en cuanto a presentación y manejo.
A choledochal cyst is a cystic dilation of the intrahepatic or extrahepatic biliary tract. According to the most accepted theory, it is caused by an anomalous pancreatobiliary junction. The most important complications are cholangiocarcinoma, lithiasis, andpancreatitis. Current therapy is surgical resection. Only 20 per cent to 30 per cent of cases are diagnosed in adult life. Two cases of choledocal cysts are reported in female adult patients, one of them in late pregnancy and the other in puerperium. Diagnosis of choledochal cyst in pregnancy and puerperium is an uncommon event, entailing particular considerations regarding symptoms and treatment.
Assuntos
Humanos , Adulto , Feminino , Gravidez , Período Pós-Parto , Cisto do Colédoco/classificação , Cisto do Colédoco/complicações , Cisto do Colédoco/etiologia , Radiografia AbdominalRESUMO
INTRODUCTION: Choledochal cysts are a rare anomaly of the biliary system; only 20-30% are diagnosed in adults. The etiology remains uncertain; however, many patients with this pathology have had an anomalous pancreatobiliary junction. AIM: To evaluate recent trends regarding diagnosis and treatment of choledochal cysts. MATERIALS AND METHODS: Review of the world literature was performed on the matter of choledochal cysts. Incidence, signs and symptoms at presentation, and diagnostic tools and therapeutics are discussed. Results of these authors are also reported. RESULTS: Estimated incidence of choledochal cyst disease varies according to population studied. It is reported mainly in children; however, an increasing number of adult patients have been diagnosed with the disease. Symptoms are often unspecific and laboratory evaluation may demonstrate no variation. Ultrasonography (US) and cholangiography are both effective in defining biliary dilatation, but endoscopic retrograde colangiopancreatography (ERCP) and recently magnetic resonance cholangiopancreatography (MRCP) have been evaluated and best visualize the pancreatobiliary junction. Treatment of choledochal cyst disease is surgical and does not depend on age of patient; nonetheless, reach patient should be properly evaluated. CONCLUSIONS: Although choledochal cysts are typically diagnosed in infancy or childhood, the surgeon should not exclude the diagnosis because the patient is an adult. Cyst excision with hepaticojejunostomy is the definitive treatment of choice; nevertheless, surgical strategy should be selected based on type of cyst and the patient.
Assuntos
Cisto do Colédoco , Adulto , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/classificação , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/terapia , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Las dilataciones quísticas congénitas del colédoco (DQC) son las formaciones congénitas con mayor riesgo de desarrollar coledocolitiasis, colestasis crónica y cáncer de las vías biliares. En el presente trabajo informamos doce casos, que corresponden al 2,4 por ciento de las 1.500 colangiopancreatografías retrógradas endoscópicas (CPRE) realizadas en los últimos 18 meses. El promedio de edad fue de 44,6 años, con predominio del género femenino (75 por ciento). El principal diagnóstico clínico anterior al examen fue la obstrucción de la vía biliar en 5 pacientes (42 por ciento); en dos casos hubo sospecha de coledocolitiasis y, en otros dos, de colelitiasis; en ninguno se hizo diagnóstico previo de quiste. Ocho pacientes tenían quiste tipo I, tres del tipo V y uno del tipo II. En 8 pacientes (58 por ciento) se realizó esfinterotomía y a 6 de ellos se les extrajeron cálculos. Las DQC se deben tener en cuenta en el diagnóstico diferencial de la enfermedad litiásica de las vías biliares y la CPRE o la colangiografía por resonancia tienen un papel preponderante en el diagnóstico. Se hace una revisión de la bibliografía