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Acquired choledochal cyst from anomalous pancreatobiliary duct union
S J Han1, E H Hwang, K S Chung
1Department of Pediatric Surgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Anomalous pancreatobiliary duct union (APBDU) may cause acquired choledochal cysts in children. This study observed progressive bile duct dilation in a child, suggesting APBDU as a potential cause of acquired choledochal cysts.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Anomalous pancreatobiliary duct union (APBDU) is frequently observed in children with choledochal cysts.
- Animal studies demonstrate bile duct dilatation following pancreatic duct-bile duct anastomosis, suggesting a link.
Observation:
- A 6-year-old boy exhibited progressive cylindrical dilatation of the common bile duct over 18 months.
- Operative cholangiogram revealed a type Ic choledochal cyst and type B APBDU (Todani classification).
Findings:
- The case suggests that APBDU can lead to the development of acquired choledochal cysts.
- A normal common bile duct in children may progressively dilate secondary to APBDU.
Implications:
- This supports APBDU as a significant etiologic factor in acquired choledochal cyst formation.
- Understanding this relationship is crucial for pediatric surgical and gastroenterological management.
- Further research into the pathogenesis of acquired choledochal cysts due to APBDU is warranted.
Abstract:
The high incidence of anomalous pancreatobiliary duct union (APBDU) in children who have a choledochal cyst has been well documented. Additionally, cylindrical dilatation of the bile duct has been reproduced in animal models by anastomosing the pancreatic duct to the bile duct. In recent years, APBDU has been considered a possible etiologic factor in the formation of a choledochal cyst. The authors observed a progressive cylindrical dilatation of the common bile duct in a 6-year-old boy over an 18-month period. An operative cholangiogram showed a type Ic choledochal cyst and a type B APBDU (Todani classification). This clinical experience suggests that a normal common bile duct in children can be progressively dilated and become an acquired choledochal cyst arising as a complication of the preexisting APBDU.