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Management of accessory hepatic ducts in choledochal cysts
K L Narasimhan1, S K Chowdhary, K L Rao
1Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Accessory hepatic ducts (AHD) can be missed during surgery for fusiform choledochal cysts (CC). Successful reimplantation of these ducts into a Roux loop is crucial for preventing complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Anatomy
Background:
- Fusiform choledochal cysts (CC) present with jaundice, fever, and pain.
- Surgical management of CC requires careful anatomical consideration.
- Accessory hepatic ducts (AHD) can complicate CC excision.
Observation:
- Two pediatric patients with type 1 CC had missed AHD on preoperative imaging.
- AHD were identified intraoperatively during CC excision.
- Vascular anomalies, such as the right hepatic artery, were closely related to the AHD.
Findings:
- Both AHD were successfully identified and reconstructed into a Roux loop with the main common hepatic duct.
- Postoperative follow-up revealed no biliary obstruction or hepatic atrophy.
- Hepatic scintigraphy demonstrated satisfactory uptake and drainage.
Implications:
- Anticipating and identifying AHD during CC excision is critical.
- Intraoperative identification and reimplantation of AHD ensure favorable outcomes.
- This surgical approach minimizes the risk of long-term biliary complications.
Abstract:
This report describes the surgical management of 2 children with fusiform choledochal cysts who had accessory hepatic ducts (AHD) identified during excisional surgery for fusiform choledochal cysts (CC). Two children presenting with a triad of recurrent jaundice, fever, and abdominal pain were investigated and found to have type 1 choledochal cyst. Preoperative imaging and intraoperative cholangiography missed the AHD in both cases. In one of the patients, the main and the accessory ducts were separated by the right hepatic artery. In both the patients the accessory ducts were reconstructed successfully into a Roux loop along with the main common hepatic duct. Follow-up studies showed no evidence of biliary tract obstruction or atrophic changes in the liver. There was satisfactory uptake and drainage on hepatic scintigraphy. During excision of CC, AHD may be encountered. These may be missed on preoperative imaging. AHD may have a close relationship with neighboring vascular structures in the porta. Accessory hepatic ducts should be anticipated, identified, and reimplanted into the Roux loop during excisional surgery.