TY - JOUR
T1 - Hepaticojejunostomy and intrahepatic cystojejunostomy for type IV-A choledochal cyst
AU - Urushihara, Naoto
AU - Fukumoto, Kouji
AU - Fukuzawa, Hiroaki
AU - Tani, Morimichi
AU - Matsuoka, Takanori
AU - Suzuki, Koumei
AU - Kawashima, Syouko
AU - Hasegawa, Shirou
PY - 2007/10
Y1 - 2007/10
N2 - Background: The incidence of choledochal cyst with intrahepatic involvement (Todani's type IV-A cyst) is considerably high. Dilatation of the intrahepatic bile duct is frequently observed around the hepatic hilum, occasionally in the umbilical portion, and rarely in the more upstream intrahepatic bile duct, associated with or without downstream stricture. We recently encountered 2 children with type IV-A cyst associated with upstream intrahepatic ductal dilatation; one with a cystic dilatation of the medial branch arising from the left hepatic duct and another with a cyst of the medial branch arising from the anterior hepatic duct. Methods: After excision of the extrahepatic bile duct cyst at the hilum and making a large fenestration of the intrahepatic duct cyst, hepaticojejunostomy and intrahepatic cystojejunostomy were performed using a Roux-en-Y jejunal loop in both children. Results: Postoperatively, both intrahepatic cysts were remarkably reduced in size, and recurrent bouts of abdominal pain did not occur for up to 4 or 5 years. Conclusion: Hepaticojejunostomy at the hepatic hilum, combined with intrahepatic cystojejunostomy, appears to be a recommendable procedure for an upstream intrahepatic ductal cyst of type IV-A, preventing postoperative cholangitis owing to bile stone formation.
AB - Background: The incidence of choledochal cyst with intrahepatic involvement (Todani's type IV-A cyst) is considerably high. Dilatation of the intrahepatic bile duct is frequently observed around the hepatic hilum, occasionally in the umbilical portion, and rarely in the more upstream intrahepatic bile duct, associated with or without downstream stricture. We recently encountered 2 children with type IV-A cyst associated with upstream intrahepatic ductal dilatation; one with a cystic dilatation of the medial branch arising from the left hepatic duct and another with a cyst of the medial branch arising from the anterior hepatic duct. Methods: After excision of the extrahepatic bile duct cyst at the hilum and making a large fenestration of the intrahepatic duct cyst, hepaticojejunostomy and intrahepatic cystojejunostomy were performed using a Roux-en-Y jejunal loop in both children. Results: Postoperatively, both intrahepatic cysts were remarkably reduced in size, and recurrent bouts of abdominal pain did not occur for up to 4 or 5 years. Conclusion: Hepaticojejunostomy at the hepatic hilum, combined with intrahepatic cystojejunostomy, appears to be a recommendable procedure for an upstream intrahepatic ductal cyst of type IV-A, preventing postoperative cholangitis owing to bile stone formation.
KW - Cholangiojejunostomy
KW - Choledochal cyst
KW - Cystojejunostomy
KW - Intrahepatic ductal dilatation
KW - Type IV-A cyst
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U2 - 10.1016/j.jpedsurg.2007.06.012
DO - 10.1016/j.jpedsurg.2007.06.012
M3 - Article
C2 - 17923209
AN - SCOPUS:34848841158
VL - 42
SP - 1753
EP - 1756
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 10
ER -