Choledochocele: Choledochal Cyst Ora Distinct Entity?

Francesca Pecchini, Barbara Catellani, Sara Acciuffi, Roberta Gelmini

Abstract


Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features.


Keywords


Choledochocele; Type III; Choledochal cyst

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References


[1] Wheeler, W. (1940). An unusual case of obstruction to the common bile duct (choledochocele?). Br J Surg, 27, 446-448

[2] Alonso, L. F., Rever, W. B., & Pessagno, D. J. (1959). Congenital choledochal cyst, with a report of two and an analysis of 94 cases. Int Abstr Surg, 108, 1-30.

[3] Todani, T., Watanabe, Y., & Narusue, M., et al. (1977). Congenital bile ductcysts cysts: Classification, operative procedures and review of thirtyseven cases including cancer arising from choledochal cyst. Am J Surg, 134, 263-269

[4] Edil, B. H., Cameron, J. L., & Reddy, S., et al. (2008). Choledochal cyst disease in children and adults: A 30-year single-institution experience. J Am Coll Surg, 206,1000-1008.

[5] Singham, J., Yoshida, E. M., & Scudamore, C. H. (2009 October). Choledochal cysts. Part 1 of 3; classification and pathogenesis. Can J Surg, 52(5), 434-40.

[6] Ziegler, K. M, Pitt, H. A. , & Zyromski, N. J., et al. (2010). Choledochoceles: Are they choledochal cysts? Ann Surg, 252, 683–690.

[7] Law, R., & Topazian, M. (2014). Diagnosis and Treatment of Choledochoceles. Clin Gastroenterol Hepatol, 12(2), 196-203.

[8] Scholz, F. J, Carrera, G. F., & Larsen, C. R. (1976 January). The choledochocele: correlation of radiological, clinical and pathological findings. Radiology, 118(1), 25-8.

[9] Sarris, G. E., & Tsang, D. (1989). Choledochocele: Case report, literature review, and a proposed classification. Surgery, 105(3), 408-14.

[10] Antaki, F., Tringali, A., & Deprez, P., et al. (2008). A case series of symptomatic intraluminal duodenal duplication cysts: Presentation, endoscopic therapy, and long-term outcome (with video). Gastrointest Endosc, 67, 163-

168.

[11] Kagiyama, S., Okazaki, K., & Yamamoto, Y. (1987). Anatomic variants of choledochocele and manometric measurements of pressure in the cele and the orifice zone. Am J Gastroenterol, 82, 641-649.

[12] Schwegler, R. A., & Boyden, E. (1937). The developmentof the pars intestinalis of the common bile duct in the human fetus, with special reference to the origin of the ampulla of Vater and the sphincter of Oddi. Anat Red, 67, 441-467.

[13] Tanaka, T. (1993). Pathogenesis of choledochocele. Am J Gastroenterol, 88, 1140.

[14] Kim, T. H., Park, J. S., & Lee, S. S., et al. (2002). Carcinoma arising in choledochocele is choledochocele innocent by stander or culprit? Endoscopy, 34, 675–677.

[15] Lipsett, P. A., & Pitt, H. A. (2003). Surgical treatment of choledochal cysts. J Hepatobiliary Pancreat Surg., 10(5), 352.

[16] Masetti, R., Antinori, A., & Coppola, R., et al. (1996). Choledochocele: Changing trends in diagnosis and management. Surg Today, 26(4), 281-5.

[17] Goldberg, P. B., Long, W. B., & Oleaga, J. A., et al. (1980). Choledochocele as a cause of recurrent pancreatitis. Gastroenterology, 78, 1041–5.

[18] Greene, F. L., Brown, J. J., Rubinstein, P., & Anderson, M. C. (1985). Choledochocele and recurrent pancreatitis. Am J Surg, 149, 306-9.

[19] Franko, J., Nussbaum, L., & Morris, J. B., et al. (2006 July-August). Choledochal cyst cholangiocarcinoma arising from adenoma: Case report and a review of the literature. Curr Surg, 63(4), 281-4.

[20] Yu, Z. L., Zhang, L. J., & Fu, J. Z., et al. (2004 ). Anomalous pancreatico-biliary junction: Image analysis and treatment principles. Hepatobiliary Pancreat Dis Int, 3(1), 136-9.

[21] Søreide, K., & Søreide, J. A. (2007 March). Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol, 14(3), 1200-11.

[22] Metcalfe, M. S., Wemyss-Holden, S. A., & Maddern, G. J. (2003). Management dilemmas with choledochal cysts. Arch Surg, 138, 333–339.

[23] Horaguchi, J., Fujita, N., & Kobayashi, G., et al. (2005). Clinical study of choledochocele: Is it a risk factor for biliary malignancies? J Gastroenterol, 40(4), 396-401.

[24] Park, K. B., Auh, Y. H., & Kim, J. H., et al. (2001). Diagnostic pitfalls in the cholangiographic diagnosis of choledochoceles: cholangiographic quality and its effect on visualization. Abdom Imaging, 26(1), 48-54.

[25] Elton, E., Hanson, B. L., & Biber, B. P., et al. (1998). Dilated common channel syndrome: endoscopic diagnosis, treatment, and relationship to choledochocele formation. Gastrointest Endosc, 47(6), 471-8.

[26] De Backer, A. I., Van den Abbeele, K., & De Schepper, A. M., et al. (2000). Choledochocele: diagnosis by magnetic resonance imaging. Abdom Imaging, 25(5), 508-10.

[27] Adamek, H. E., Schilling, D., & Weitz, M., et al. (2000). Choledochocele imaged with magnetic resonance cholangiography. Am J Gastroenterol, 95(4), 1082-3.

[28] Ulas, M., Polat, E., & Karaman, K., et al. (2012). Management of choledochal cysts in adults: A retrospective analysis of 23 patients. Hepatogastroenterology, 59(116), 1155-9.

[29] Sato, M., Ishida, H., & Konno, K., et al. (2001). Choledochal cyst due to anomalous pancreatobiliary junction in the adult: sonographic findings. Abdom Imaging, 26(4), 395-400.

[30] Azzik, H., Colankoglu, S. O., & Ergun, Y., et al. (1997). Endoscopic retrograde cholangiopancreatography in the diagnosis and management of choledochal cysts. HBP Surg, 10(4), 211-8.

[31] Berger, A., Doudard, R., & Landi, B., et al. (2007). Endoscopic management of a large choledochocele associated with choledocholithiasis. Gastroenetrol Clin Biol, 31, 200-203.

[32] Belli, G., Rotondano, G., & D’Agostino, A., et al. (1998). Cystic dilatation of extrahepatic bile ducts in adulthood: Diagnosis, surgical treatment and long-term results. HPB Surg, 10(6), 379-84.

[33] Dehyle, S. P., & Meyer, H. J. (1974). Perorale endoskopisch-elektrochirurgische Abtragung einer Choledochocele. Dtsch Med Wochenschr, 99,71-72.

[34] Siegel, J. H., Harding, G. T., & Chateau, F. (1981). Endoscopic incision of choledochal cysts (choledochocele). Endoscopy, 13, 200-202.

[35] Nagasawa, S., Tanaka, M., & Seki, H., et al. (1983). Choledochocele: 2 cases with endoscopic papillotomy. Nihon Shokakibyo Gakkai Zasshi, 80, 1490–1495.

[36] Katsinelos, P., Dimiropoulos, S., & Galanis, I., et al. (2003 Jan). Needle-knife sphincterotomy. Surg Endosc, 17(1), 158.

[37] Ohtsuka, T., Inoue, K., & Ohuchida, J., et al. (2001). Carcinoma arising in choledochocele. Endoscopy, 33, 614-9

[38] Singham, J., Yoshida, E. M., & Scudamore, C. H. (2010 February). Choledochal cysts. Part 3 of 3; menagement. Can J Surg, 53(1), 51-6.

[39] Popova-Jovanovska, R. Genadieva-Dimitrova, M., & Trajkovska, M. et al. (2012 Jul). Choledochal cysts: Diagnosis and treatment. Prilozi, 33(1), 49-33.

[40] Naga, M. I., & Suleiman, D. N. (2004 Mar). Endoscopic management of choledochal cyst. Gastrointest Endosc, 59(3), 427-32.

[41] Martin, R. F., Biber, B. P., & Bosco, J. J., et al. (1992 May). Symptomatic choledochoceles in adults. Endoscopic retrograde cholangiopancreatography recognition and management. Arch Surg, 127(5), 536-8.

[42] Kouraklis, G., Misiakos, E., & Glinavou, A., et al. (1996). Cystic dilatations of the common bile duct in adults. HPB Surg, 10(2), 91-4.

[43] Spier, L. N., Crystal, K., & Kase, D. J., et al. (1995 April). Choledochocele: newer concepts of origin and diagnosis. Surgery, 117(4), 476-8.

[44] Wearn, F. G., & Wiot, J. F., et al. (1982). Choledochocele: Not form of choledochal cyst. J Can Assoc Radiol, 33(2), 110-2.

[45] Zhu, L., Zeng, H., & Chen, Y. X., et al. (2014). Endoscopic management of choledochocele complicated with choledocholithiasis and pancreatitis in an old patient. Aging Clin Exp Res [Epub ahead of print]

[46] Garrido, A., Léon, R., Lopez, J., & Marquez, J. L. (2012). An exceptional case of choledochocele and pancreas divisum in an elderly man. Gastroenterol Hepatol, 35(1), 8-11.

[47] Martínez-Ordaz, J. L., & Niño-Solis, J. (2010). Choledochal cysts in adults. Cir Cir., 78(1), 61-6.

[48] Wang, G. Q., & Zahng, S. T. (2009). A rare case of bile duct cyst. World J Gastroenterol, 28(20), 2550-1.

[49] Gordon, S. R., Levenick, J. M., & Rath, D. L. (2009). Case of a closed choledochocele with biliary and pancreatic drainage via the accessory duct causing acute pancreatitis. Dig Endosc, 21(2), 106-8.

[50]Uribarrena, A. R., Raventós, N., & Fuentes, J., et al. (2008 ). Diagnosis and management of choledochal cysts. A review of 10 new cases. Rev Esp Enferm Dig, 100(2), 71-5.

[51] Can, M. F., Kaymakçioğlu, N., & Yağci, G. (2006). An adult choledochocele case presented with gastric outlet obstruction: a rare presentation. Turk J Gastroenterol, 17(1),

70-3.

[52] Safioleas, M. C., Moulakakis, K. G., & Misiakos, E. P., et al. (2005). Surgical management of choledochal cysts in adults. Hepatogastroenteroly, 52(64), 1030-3.

[53] García-Cano, J, Nieto J, & Godoy, M. A., et al. (2005 December). Small size choledochocele as a cause of chronic epigastric pain: diagnosis and treatment by means of ERCP. An Med Interna, 22(12), 591-3.

[54] Park, D. H., Kim, M. H., & Lee, S. K., et al. (2005). Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts? Gastrointest Endosc, 62(3), 360-6.

[55] Jordan, P. H. Jr, Goss, J. A. Jr, & Rosenberg, W. R., et al. (2004 Mar). Some considerations for management of choledochal cysts. Am J Surg, 187(3), 434-9.

[56] Rabie, M. E., Al-Humayed, S. M., & Hosni, M. H., et al. (2002 October-December). Choledochocele: The disputed origin. Int Surg, 87(4), 221-5.




DOI: http://dx.doi.org/10.3968/gh.v2i1.5290

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