ABSTRACT
AIM: the aim of this study was to analyze the diagnostic and therapeutic options for the various types of this rare disease. PATIENTS AND METHODS: 10 patients with choledochal cysts (CC) were diagnosed in our hospital since 1991. Type of cyst was established according to the Alonso-Lej classification. RESULTS: we report 7 type-I, 1 type-III, 1 type-IVa, and 1 type-V CC cases. Clinical manifestations were abdominal pain in all cases with biliary or pancreatic features. The diagnosis was established using abdominal ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography (ERCP). All 7 patients with type-I CC underwent total cyst excision with Roux-en-Y hepatojejunostomy. For type-III CC an endoscopic sphincterotomy (ES) was performed, and in type-IVa CC a transductal sphincterotomy and cholecistectomy was made. The patient with Caroli s disease (type V) underwent liver transplantation. We have followed up all patients for several years without significant complications. CONCLUSIONS: CC is more frequent in childhood, but is not exceptional in the adult. Imaging techniques and ERCP play an important role in the diagnosis, and also in the treatment of type-III cysts. Therapeutic options depend on cyst type, but due to the potential malignancy of this disease total cyst excision is recommended for types I, II and IV. In type-III CC endoscopic sphyncterothomy is recommended, while liver transplantation is sometimes necessary for type V. Long-term follow-up is crucial to prevent malignant transformation except for type-III CC where this complication is very unusual.
Subject(s)
Choledochal Cyst/diagnosis , Choledochal Cyst/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo: analizar las técnicas diagnósticas y las distintas posibilidadesterapéuticas de esta rara patología.Pacientes y métodos: presentamos un estudio retrospectivode todos los casos de quistes de colédoco diagnosticados en nuestrohospital desde 1991. Incluye 10 nuevos casos y distintos tiposde quistes de colédoco (QC).Resultados: de los 10 pacientes diagnosticados de QC sietetenían menos de 10 años. En cuanto a los diferentes tipos de QC:7 eran de tipo I, 1 de tipo III, 1 de tipo IVa y otro de tipo V. Lasmanifestaciones clínicas habitualmente tenían un perfil biliar opancreático. El diagnóstico se ha realizado mediante técnicas deimagen no invasivas (ECO, TAC) y CPRE. El tratamiento ha venidocondicionado por el tipo de quiste: quistectomía con hepaticoyeyunostomíaen Y de Roux en los de tipo I, CPRE con esfinterotomíaendoscópica en los de tipo III y trasplante hepático en laenfermedad de Caroli. En el único QC tipo IVa se realizó una papilotomíatransductal y una colecistectomía. Todos han sido controladosperiódicamente, sin que hayamos registrado complicacionesrelevantes durante el seguimiento.Conclusión: los QC son más frecuentes en niños pero no sonexcepcionales en adultos. Las técnicas de imagen y la CPRE sonesenciales en el diagnóstico de esta patología. El tratamiento dependerádel tipo de quiste de colédoco. Es aconsejable el seguimientoperiódico y prolongado de estos pacientes para detectarprecozmente complicaciones como la transformación maligna
Aim: the aim of this study was to analyze the diagnostic and therapeuticoptions for the various types of this rare disease.Patients and methods: 10 patients with choledochal cysts(CC) were diagnosed in our hospital since 1991. Type of cyst wasestablished according to the Alonso-Lej classification.Results: we report 7 type-I, 1 type-III, 1 type-IVa, and 1 type-VCC cases. Clinical manifestations were abdominal pain in all caseswith biliary or pancreatic features. The diagnosis was established usingabdominal ultrasonography, computed tomography, and endoscopicretrograde cholangiopancreatography (ERCP). All 7 patientswith type-I CC underwent total cyst excision with Roux-en-Y hepatojejunostomy.For type-III CC an endoscopic sphincterotomy (ES) wasperformed, and in type-IVa CC a transductal sphincterotomy andcholecistectomy was made. The patient with Carolis disease (type V)underwent liver transplantation. We have followed up all patients forseveral years without significant complications.Conclusions: CC is more frequent in childhood, but is not exceptionalin the adult. Imaging techniques and ERCP play an importantrole in the diagnosis, and also in the treatment of type-III cysts.Therapeutic options depend on cyst type, but due to the potentialmalignancy of this disease total cyst excision is recommended fortypes I, II and IV. In type-III CC endoscopic sphyncterothomy is recommended,while liver transplantation is sometimes necessary fortype V. Long-term follow-up is crucial to prevent malignant transformationexcept for type-III CC where this complication is very unusual
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Choledochal Cyst/diagnosis , Choledochal Cyst/surgery , Retrospective StudiesABSTRACT
The authors studied 7 cases of peptic ulcers (2 gastric and 5 duodenals) in patients whose ages ranged between 3 and 13 4/12 years. They represented 0.5% of hospital inpatients. A history of acetyl salicilic acid ingestion was present in 3 of the cases. In 2 of the cases emotional factors were associated. Initial symptoms were distributed as follows: abdominal (4), hematemesis (2) and melena (1). The clinical course was favorable for 5 of the patients; in one of them signs of bulboduodenitis became evident in the fourth month; in another one the clinical signs persisted and a new ulcer appeared 4 months after the initial diagnosis. High levels of gastrin were found in this case. The importance of gastroduodenal fiberendoscopy in infancy for the diagnosis, histological confirmation and follow-up of peptic ulcer is emphasized.
