Year 2019 / Volume 111 / Number 8
Letter
A degenerate Todani Ia choledochal cyst in a patient with pancreas divisum

650-651

DOI: 10.17235/reed.2019.6095/2018

José Francisco Sánchez Melgarejo, José Maria Rubio Mateos, María Josefa Sánchez Fernández,

Abstract
Bile duct cysts represent congenital abnormalities associated with biliopancreatic maljunction that may undergo malignant degeneration. We report herein the case of a 72-year-old male patient with cholangitis. MR-cholangiography and abdominal CT revealed a mass at the biliary-pancreatic-duodenal crossroads, extrahepatic biliary dilation up to 38 mm, and pancreas divisum. Gastroscopy found an infiltrative bulbar mucosa with adenocarcinoma in biopsy samples, and extrinsic bulging of the second duodenal portion. Endoscopic ultrasound showed a choledochal cystic dilation with solid contents, and FNA findings were nonspecific. ERCP confirmed an adenomatous papilla at the lower portion of the extrinsic formation, and a large cystic, saccular dilation of extrahepatic bile ducts (Todani Ia). Fistulotomy was required for deep cannulation of the proximal biliary tract, and attention was drawn to extruding polypoid lesions originating in the biliary epithelium, identified in biopsies as adenoma with dysplasia. Finally, a diagnosis was made of advanced adenocarcinoma in choledochal cyst.
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References
1. Gómez Sánchez J, Rubio López J, Pérez Cabrera B et al. Todani Ic cystic dilatation of the bile duct. Rev Esp Enferm Dig. 2018;110
2. Ragot E, Mabrut J-Y, Ouaïssi M et al. Pancreaticobiliary Maljunctions in European Patients with Bile Duct Cysts: Results of the Multicenter Study of the French Surgical Association (AFC). World J Surg. 2017;41(2):538–45.
3. Ransom-Rodríguez A, Blachman-Braun R, Sánchez-García Ramos E et al. A rare case of choledochal cyst with pancreas divisum: case presentation and literature review. Ann Hepato-Biliary-Pancreatic Surg. 2017;21(1):52.
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Sánchez Melgarejo J, Rubio Mateos J, Sánchez Fernández M. A degenerate Todani Ia choledochal cyst in a patient with pancreas divisum. 6095/2018


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Publication history

Received: 05/12/2018

Accepted: 12/12/2018

Online First: 18/07/2019

Published: 31/07/2019

Article Online First time: 225 days

Article editing time: 238 days


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