Background and aim Bile duct cysts are defined as dilation of extrahepatic or intrahepatic biliary three. Biliary cyst are classified following the Todani classification and are divided in V types. They account for approximately 1% of all benign biliary disease. The incidence of the biliary cyst in Europe is 1-2/1.000.000. The Todani type-III is very rarely and account in 2-4% of all Todani cysts. The risk of developing a cholangiocarcinoma range from 2.5 to 28%, increasing with age. Choledocolithiasis, cholelitiasis, hepatolithiasis, cholangitis, pancreatitis and spontaneous cyst perforation represent the consequences of the Todani cysts. Materials and methods We describe a case of a 17 years-old latinos-man with a systemic candidosis developed after necrotic-hemorrhage acute pancreatitis (NHAP) caused from a choledocical cyst transferred to our unit 35 days after a failed attempt of ERCP. The patient presented right kidney agenesis. Results The patient came in our hospital in very poor clinical conditions with high inflammatory indexes and cholestasis. A CT scan was performed showing the supposed presence of lithiasis inside the choledocical cyst with a dilated common bile duct (CBD). Pancreatic isthmus and tail presented necrotic-hemorrage areas. Another ERCP was attempted in our unit but unsuccessful. Three days later we decided to study the bilio-pancreatic area by endo-ultrasonography (EUS). EUS showed the cyst completely full of stones, in continuation with CBD and occluding it. With the duodenoscope we decided to perform a cystotomy with a needle knife, opening the cyst. The stones was then totally removed. The patient died 4 days later because of multi organ failure (MOF) for systemic sepsis. Conclusion Necrotic-hemorrhage acute pancreatitis is a life-threatening condition, especially in patient with poor clinical conditions. Endoscopic cystotomy could be the treatment of choledocical Todani type-III cyst, expecially in patient with an unsuccessful attempt of ERCP. This treatment is not actually described.
EUS-ERCP in the treatment of Todani type-III cyst causing necrotic haemorrage acute pancreatitis
Mangiavillano B;
2015-01-01
Abstract
Background and aim Bile duct cysts are defined as dilation of extrahepatic or intrahepatic biliary three. Biliary cyst are classified following the Todani classification and are divided in V types. They account for approximately 1% of all benign biliary disease. The incidence of the biliary cyst in Europe is 1-2/1.000.000. The Todani type-III is very rarely and account in 2-4% of all Todani cysts. The risk of developing a cholangiocarcinoma range from 2.5 to 28%, increasing with age. Choledocolithiasis, cholelitiasis, hepatolithiasis, cholangitis, pancreatitis and spontaneous cyst perforation represent the consequences of the Todani cysts. Materials and methods We describe a case of a 17 years-old latinos-man with a systemic candidosis developed after necrotic-hemorrhage acute pancreatitis (NHAP) caused from a choledocical cyst transferred to our unit 35 days after a failed attempt of ERCP. The patient presented right kidney agenesis. Results The patient came in our hospital in very poor clinical conditions with high inflammatory indexes and cholestasis. A CT scan was performed showing the supposed presence of lithiasis inside the choledocical cyst with a dilated common bile duct (CBD). Pancreatic isthmus and tail presented necrotic-hemorrage areas. Another ERCP was attempted in our unit but unsuccessful. Three days later we decided to study the bilio-pancreatic area by endo-ultrasonography (EUS). EUS showed the cyst completely full of stones, in continuation with CBD and occluding it. With the duodenoscope we decided to perform a cystotomy with a needle knife, opening the cyst. The stones was then totally removed. The patient died 4 days later because of multi organ failure (MOF) for systemic sepsis. Conclusion Necrotic-hemorrhage acute pancreatitis is a life-threatening condition, especially in patient with poor clinical conditions. Endoscopic cystotomy could be the treatment of choledocical Todani type-III cyst, expecially in patient with an unsuccessful attempt of ERCP. This treatment is not actually described.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
