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Does Congenital Biliary Dilatation Todani Type II (Diverticular Type) Really Exist?
Takeshi Saito1, Hisami Ando2, Shin Ishihara3
1Department of Pediatric Surgery, Chiba Children's Hospital, Japan.
Journal of Pediatric Surgery
|November 18, 2023
Summary
Diverticular congenital biliary dilatation (CBD) is rarely diagnosed correctly due to a lack of clear definitions. This study found authentic cases of diverticular CBD are extremely rare, questioning current classifications.
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Pathology
Background:
- Congenital biliary dilatation (CBD) encompasses various biliary tract abnormalities.
- Diverticula of the common bile duct are a less understood subtype.
- Accurate diagnosis and classification are crucial for effective management.
Purpose of the Study:
- To clarify the clinicopathological and biliary morphological characteristics of reported diverticular congenital biliary dilatation (CBD) cases.
- To investigate the diagnostic criteria and prevalence of true diverticular CBD.
Main Methods:
- Systematic literature review of PubMed and Japan Medical Abstracts Society databases.
- Analysis of 211 reported cases for clinical and morphological features.
- Examination of original articles by Alonso-Lej and Todani for definitions of diverticular CBD and pancreaticobiliary maljunction (PBM).
Main Results:
- Of 211 cases, 88% had single diverticula, 12% multiple; locations varied.
- Associated conditions included PBM (39%), intra-diverticular stones (23%), and biliary carcinoma (11%).
- Only 6 cases (2.8%) met criteria for authentic diverticular CBD with a specific morphology.
Conclusions:
- True diverticular congenital biliary dilatation (CBD) is exceptionally rare.
- Lack of objective definition leads to diagnostic inconsistencies and challenges conventional classifications.
- Re-evaluation of diagnostic criteria for diverticular CBD is warranted.
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