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Updated: Aug 29, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
[Biliary tract dilatation and abnormal choledocho-pancreatic ductal junction in children]
U Tannuri1, J H Pessoa, P T Sakane
1Disciplina de Cirurgia Pediátrica de FMUSP, São Paulo, SP, Brazil.
Insights
Congenital biliary tract dilatation in children is often caused by a long common channel, leading to reflux and inflammation. Surgical correction, Roux-en-Y hepatic-jejunostomy, effectively resolves symptoms.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Context:
- Congenital dilatation of the extrahepatic biliary tract is a rare condition in children.
- Abnormal choledochopancreatic ductal junction can lead to pancreatic juice reflux into the biliary system.
- This reflux causes chronic inflammation, fibrosis, and subsequent biliary dilatation.
Purpose:
- To present a series of pediatric cases with congenital biliary tract dilatation.
- To investigate the role of abnormal choledochopancreatic ductal junction in the pathogenesis of this condition.
- To evaluate the efficacy of surgical management.
Summary:
- Nine children (2 months–11 years) with congenital biliary tract dilatation were studied.
- Radiological findings in eight patients revealed an abnormal choledochopancreatic ductal junction, forming a long common channel.
- Clinical presentations included abdominal pain, vomiting, obstructive jaundice, or a palpable mass. Diagnosis utilized ultrasound, laparotomy, and cholangiography.
- All patients underwent Roux-en-Y hepatic-jejunostomy, with successful asymptomatic outcomes post-surgery.
Impact:
- Highlights the significance of the long common channel in pediatric biliary dilatation.
- Demonstrates the effectiveness of Roux-en-Y hepatic-jejunostomy for surgical correction.
- Provides valuable insights for diagnosing and managing congenital biliary tract anomalies in children.
Abstract:
Nine children aged between 2 months and 11 years, who had congenital dilatation of extrahepatic biliary tract, with or without intrahepatic dilatation, are presented. The radiological studies performed in eight patients demonstrated abnormal choledochopancreatico ductal junction. Thus, a long common channel is formed out of the duodenal wall, leading to a continuous reflux of pancreatic juice into the biliary system, chronic inflammation of biliary tract wall, fibrosis of muscular layer and finally different types of dilatations. The main clinical findings were upper abdominal pain, vomiting, or obstructive jaundice. In only one child the dilatation was cystic type and the clinical manifestation was palpable abdominal mass. In eight patients the initial diagnosis of biliary tract dilatation was made through abdominal ultrasound and in one case by direct visualization through emergent exploratory laparotomy. The final confirmation of the presence of long common channel was made by preoperative endoscopic retrograde cholangiopancreatography or intraoperative cholangiogram. The radiologic investigation was not performed in only one case due to bad clinical conditions. The surgical treatment indicated to all cases was Roux- en- Y hepatic- jejunostomy. The late follow up demonstrated that all patients are well and assymptomatic.
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