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Symptomatic Choledochoceles in Adults: Endoscopic Retrograde Cholangiopancreatography Recognition and Management

Symptomatic Choledochoceles in Adults: Endoscopic Retrograde Cholangiopancreatography Recognition... Abstract • During a 2-year interval, we identified 10 patients with symptoms of pancreaticobiliary disorders and small choledochoceles by endoscopic retrograde cholangiopancreatography. Patients ranged from 36 to 89 years of age. Eight were female. Seven presented with recurrent, acute pancreatitis, two presented with biliary colic, and one presented with cholangitis. Dilated common bile ducts were seen in four patients, and no other biliary lesions were demonstrated in any patients. Five patients were shown to have normal gallbladders by ultrasonographic or computed tomographic criteria. Choledochoceles were identified endoscopically as a bulge above or involving the ampulla. Diagnosis was confirmed by cholangiography. All patients underwent successful unroofing of the choledochocele and sphincterotomy of the common bile duct. One pancreatic sphincterotomy was performed for pancreatic ductal obstruction. We encountered no complications. Hospital stays ranged from 1 to 4 days. Follow-up intervals ranged from 2 to 20 months. At this time, no patients have had any recurrence of symptoms, and none has required rehospitalization or surgery. (Arch Surg. 1992;127:536-539) References 1. Babbit DP. Congenital cysts: new etiologic concept based on anomalous relationships of the common bile duct and pancreatic bulb . Ann Radiol. 1969;12:231-240. 2. Okada A, Nakamura T, Hiyaki J, Okumura K, Kamata S, Ogichi Y. Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction . Surg Gynecol Obstet . 1990;171:291-298. 3. Saveder SJ, Benenati JF, Venbrux AC, et al. Choledochal cysts: classification and cholangiographic appearance . AJR Am J Roentgenol . 1991;156:327-331.Crossref 4. Venu RP, Geenen JE, Hogan WJ, et al. Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of choledochoceles . Gastroenterology . 1984;87:1144-1149. 5. Ponce J, Garrigues V, Sala T, Pertejo V, Berenguer J. Endoscopic 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.Crossref 6. Howard ER. Choledochal cysts . In: Schwartz SE, Ellis H, eds. Maingot's Abdominal Operations . 9th Ed. East Norwalk, Conn: Appleton & Lange; 1989;2:1365-1379. 7. Joseph VT. Surgical techniques and long-term results in the treatment of choledochal cyst . J Pediatr Surg . 1990;25:782-787.Crossref 8. Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM. Variation in management based on type of choledochal cyst . Am J Surg . 1991;161:612-615.Crossref 9. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts . Am J Surg . 1977;134:263-269.Crossref 10. Alonso-Lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cysts, with a report of 2 and analysis of 94 cases . Int Abstr Surg . 1959;108:1-30. 11. Vater A, Ezler CS. Dissertatio de schirrus viscerum occasione sectionis viri tympanite defunte . Wittenburgae 1723, 4 Pamphlers, 881:22. 12. Wheeler WC. An unusual case of obstruction of the common bile duct (choledochocele?) . Br J Surg . 1940;27:446-448.Crossref 13. Sarris GE, Tsang D. Choledochocele: case report, literature review and a proposed classification . Surgery . 1989;105:408-414. 14. Wiedmeyer DA, Stewart ET, Dodds WJ, Geenen JE, Vennes JA, Taylor AJ. Choledochal cyst: findings on cholangiopancreatography with emphasis on ectasia of the common channel . AJR Am J Roentgenol . 1989;153:969-972.Crossref 15. Lygidakis NJ. Cystic dilatation of the common bile duct . Surg Gynecol Obstet . 1985;160:115-118. 16. Ono J, Sakoda K, Akita H. Surgical aspect of cystic dilatation of the bile duct: an anomalous junction of the pancreaticobiliary tract in adults . Ann Surg . 1982;195:203-208.Crossref 17. Donald JJ, Coral A, Lees WR. Choledochocele complicated by carcinoma . Clin Radiol . 1989;40:101-103.Crossref 18. Iwai N, Deguchi E, Yanagihara J, et al. Cancer arising in a choledochal cyst in a 12-year-old girl. ] Pediatr Surg . 1990;25:1261-1263.Crossref 19. Yoshida H, Itai Y, Minami M, Kokubo K, Ohtomo K, Kuroda A. Biliary malignancies occurring in choledochal cysts . Radiology . 1989;173:389-392.Crossref 20. Mirsa SP, Gulati P, Thorat VK, Vij JC, Anand BS. Pancreaticobiliary ductal union in biliary diseases: an endoscopic retrograde cholangiopancreatographic study . Gastroenterology . 1989;96:907-912. 21. Ozawa K, Yamada T, Matumoto Y, Tobe R. Carcinoma arising in a choledochocele . Cancer . 1980;45:195-197.Crossref 22. Todani T, Tabuchi K, Watanabe Y, Kabayashi T. Carcinoma arising in the wall of congenital bile duct cysts . Cancer . 1979;44:1134-1141.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Symptomatic Choledochoceles in Adults: Endoscopic Retrograde Cholangiopancreatography Recognition and Management

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References (25)

Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1992.01420050056007
Publisher site
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Abstract

Abstract • During a 2-year interval, we identified 10 patients with symptoms of pancreaticobiliary disorders and small choledochoceles by endoscopic retrograde cholangiopancreatography. Patients ranged from 36 to 89 years of age. Eight were female. Seven presented with recurrent, acute pancreatitis, two presented with biliary colic, and one presented with cholangitis. Dilated common bile ducts were seen in four patients, and no other biliary lesions were demonstrated in any patients. Five patients were shown to have normal gallbladders by ultrasonographic or computed tomographic criteria. Choledochoceles were identified endoscopically as a bulge above or involving the ampulla. Diagnosis was confirmed by cholangiography. All patients underwent successful unroofing of the choledochocele and sphincterotomy of the common bile duct. One pancreatic sphincterotomy was performed for pancreatic ductal obstruction. We encountered no complications. Hospital stays ranged from 1 to 4 days. Follow-up intervals ranged from 2 to 20 months. At this time, no patients have had any recurrence of symptoms, and none has required rehospitalization or surgery. (Arch Surg. 1992;127:536-539) References 1. Babbit DP. Congenital cysts: new etiologic concept based on anomalous relationships of the common bile duct and pancreatic bulb . Ann Radiol. 1969;12:231-240. 2. Okada A, Nakamura T, Hiyaki J, Okumura K, Kamata S, Ogichi Y. Congenital dilatation of the bile duct in 100 instances and its relationship with anomalous junction . Surg Gynecol Obstet . 1990;171:291-298. 3. Saveder SJ, Benenati JF, Venbrux AC, et al. Choledochal cysts: classification and cholangiographic appearance . AJR Am J Roentgenol . 1991;156:327-331.Crossref 4. Venu RP, Geenen JE, Hogan WJ, et al. Role of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of choledochoceles . Gastroenterology . 1984;87:1144-1149. 5. Ponce J, Garrigues V, Sala T, Pertejo V, Berenguer J. Endoscopic 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.Crossref 6. Howard ER. Choledochal cysts . In: Schwartz SE, Ellis H, eds. Maingot's Abdominal Operations . 9th Ed. East Norwalk, Conn: Appleton & Lange; 1989;2:1365-1379. 7. Joseph VT. Surgical techniques and long-term results in the treatment of choledochal cyst . J Pediatr Surg . 1990;25:782-787.Crossref 8. Lopez RR, Pinson CW, Campbell JR, Harrison M, Katon RM. Variation in management based on type of choledochal cyst . Am J Surg . 1991;161:612-615.Crossref 9. Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts . Am J Surg . 1977;134:263-269.Crossref 10. Alonso-Lej F, Rever WB Jr, Pessagno DJ. Congenital choledochal cysts, with a report of 2 and analysis of 94 cases . Int Abstr Surg . 1959;108:1-30. 11. Vater A, Ezler CS. Dissertatio de schirrus viscerum occasione sectionis viri tympanite defunte . Wittenburgae 1723, 4 Pamphlers, 881:22. 12. Wheeler WC. An unusual case of obstruction of the common bile duct (choledochocele?) . Br J Surg . 1940;27:446-448.Crossref 13. Sarris GE, Tsang D. Choledochocele: case report, literature review and a proposed classification . Surgery . 1989;105:408-414. 14. Wiedmeyer DA, Stewart ET, Dodds WJ, Geenen JE, Vennes JA, Taylor AJ. Choledochal cyst: findings on cholangiopancreatography with emphasis on ectasia of the common channel . AJR Am J Roentgenol . 1989;153:969-972.Crossref 15. Lygidakis NJ. Cystic dilatation of the common bile duct . Surg Gynecol Obstet . 1985;160:115-118. 16. Ono J, Sakoda K, Akita H. Surgical aspect of cystic dilatation of the bile duct: an anomalous junction of the pancreaticobiliary tract in adults . Ann Surg . 1982;195:203-208.Crossref 17. Donald JJ, Coral A, Lees WR. Choledochocele complicated by carcinoma . Clin Radiol . 1989;40:101-103.Crossref 18. Iwai N, Deguchi E, Yanagihara J, et al. Cancer arising in a choledochal cyst in a 12-year-old girl. ] Pediatr Surg . 1990;25:1261-1263.Crossref 19. Yoshida H, Itai Y, Minami M, Kokubo K, Ohtomo K, Kuroda A. Biliary malignancies occurring in choledochal cysts . Radiology . 1989;173:389-392.Crossref 20. Mirsa SP, Gulati P, Thorat VK, Vij JC, Anand BS. Pancreaticobiliary ductal union in biliary diseases: an endoscopic retrograde cholangiopancreatographic study . Gastroenterology . 1989;96:907-912. 21. Ozawa K, Yamada T, Matumoto Y, Tobe R. Carcinoma arising in a choledochocele . Cancer . 1980;45:195-197.Crossref 22. Todani T, Tabuchi K, Watanabe Y, Kabayashi T. Carcinoma arising in the wall of congenital bile duct cysts . Cancer . 1979;44:1134-1141.Crossref

Journal

Archives of Surgery – American Medical Association

Published: May 1, 1992

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