Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Simultaneous laparoscopic removal of a Todani type II choledochal cyst and a microlithiasic cholecystitis

  • Alfonso Grottesi (Unit of General Surgery, Sandro Pertini Hospital) ;
  • Simonetta Iacovitti (Unit of General Surgery, Sant'Eugenio Hospital) ;
  • Paolo Ciano (Unit of General Surgery, Sandro Pertini Hospital) ;
  • Francesco Borrini (Unit of Pathology, Sandro Pertini Hospital) ;
  • Maddalena Zippi (Unit of Gastronterology and Digestive Endoscopy, Sandro Pertini Hospital)
  • Received : 2022.02.09
  • Accepted : 2022.03.10
  • Published : 2022.08.31
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Abstract

Diverticula of the choledochus, better known as Todani type II cysts, are very rare and represent a predominantly pediatric pathology. Their identification by radiological methods, even if occasional, requires clinical doctors to request a surgical consultation, even for asymptomatic subjects, to proceed with their removal, given the risk of associated neoplasms. The laparoscopic approach for surgical treatment of these cysts has been recently introduced with excellent results. Due to the poor clinical records, currently there are neither shared protocols about their management nor long-term follow-up of operated patients. We report a case of an adult female suffering for years from biliary colic due to the presence of a duodenal diverticulum associated with microlithiasis' cholecystitis, who was laparoscopically treated, with excellent results in terms of symptomatic regression, reduced hospitalization, and no surgery-related complications.

Keywords

Acknowledgement

We thank Dr. Saveria de Vito, Italian Medicines Agency, Rome, Italy, for the English revision of the manuscript.

References

  1. Singham J, Yoshida EM, Scudamore CH. Choledochal cysts: part 1 of 3: classification and pathogenesis. Can J Surg 2009;52:434-440.
  2. Babbitt DP. [Congenital choledochal cysts: new etiological concept based on anomalous relationships of the common bile duct and pancreatic bulb]. Ann Radiol (Paris) 1969;12:231-240. Multiple languages.
  3. Hosoki T, Hasuike Y, Takeda Y, Michita T, Watanabe Y, Sakamori R, et al. Visualization of pancreaticobiliary reflux in anomalous pancreaticobiliary junction by secretin-stimulated dynamic magnetic resonance cholangiopancreatography. Acta Radiol 2004;45:375-382.
  4. Spitz L. Experimental production of cystic dilatation of the common bile duct in neonatal lambs. J Pediatr Surg 1977;12:39-42.
  5. Kusunoki M, Saitoh N, Yamamura T, Fujita S, Takahashi T, Utsunomiya J. Choledochal cysts. Oligoganglionosis in the narrow portion of the choledochus. Arch Surg 1988;123:984-986.
  6. Ponce J, Garrigues V, Sala T, Pertejo V, Berenguer J. Endoscopic biliary manometry in patients with suspected sphincter of Oddi dysfunction and in patients with cystic dilatation of the bile ducts. Dig Dis Sci 1989;34:367-371.
  7. Gigot J, Nagorney D, Farnell M, Moir C, Ilstrup D. Bile duct cysts: a changing spectrum of presentation. J Hep Bil Pancr Surg 1996;3:405-411.
  8. O'Neill JA Jr. Choledochal cyst. Curr Probl Surg 1992;29:361-410.
  9. Liu CL, Fan ST, Lo CM, Lam CM, Poon RT, Wong J. Choledochal cysts in adults. Arch Surg 2002;137:465-468.
  10. 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;108:1-30.
  11. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263-269.
  12. Soares KC, Arnaoutakis DJ, Kamel I, Rastegar N, Anders R, Maithel S, et al. Choledochal cysts: presentation, clinical differentiation, and management. J Am Coll Surg 2014;219:1167-1180.
  13. Darnis B, Mohkam K, Cauchy F, Cazauran JB, Bancel B, Rode A, et al. A systematic review of the anatomical findings of multiple gallbladders. HPB (Oxford) 2018;20:985-991.
  14. Kumar S, Kumar A, Singh VP. Gallbladder duplication in a child with choledochal cyst: a rare surgical surprise. BMJ Case Rep 2021;14:e245109.
  15. Badebarin D, Aslanabadi S, Teimouri-Dereshki A, Jamshidi M, Tarverdizadeh T, Shad K, et al. Different clinical presentations of choledochal cyst among infants and older children: a 10-year retrospective study. Medicine (Baltimore) 2017;96:e6679.
  16. Soreide K, Soreide JA. Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol 2007;14:1200-1211.
  17. Senthilnathan P, Patel ND, Nair AS, Nalankilli VP, Vijay A, Palanivelu C. Laparoscopic management of choledochal cyst-technical modifications and outcome analysis. World J Surg 2015;39:2550-2556.
  18. Liu DC, Rodriguez JA, Meric F, Geiger JL. Laparoscopic excision of a rare type II choledochal cyst: case report and review of the literature. J Pediatr Surg 2000;35:1117-1119.
  19. Hwang DW, Lee JH, Lee SY, Song DK, Hwang JW, Park KM, et al. Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults. Surg Endosc 2012;26:3324-3329.
  20. Martin RF. Biliary cysts: a review and simplified classification scheme. Surg Clin North Am 2014;94:219-232.
  21. Lopez-Marcano A, de la Plaza-Llamas R, Ramia JM, Al-Shwely F, Gonzales-Aguilar J, Medina Velasco A. Laparoscopic approach to the treatment of type II choledocal cysts. Gastroenterol Hepatol 2017;40:678-680.