|
1
|
Amgad A, Abdelmohsen SM, Ali AK, Sabra TA. Multiseptate gallbladder in a pediatric pateint: A case report and review of literature. Int J Surg Case Rep 2024; 123:110317. [PMID: 39303484 PMCID: PMC11437745 DOI: 10.1016/j.ijscr.2024.110317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/11/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Multiseptate gallbladder (MSG) is an uncommon congenital condition characterized by internal septa dividing the gallbladder into multiple compartments. This condition poses unique challenges in diagnosis and management due to its rarity and varied clinical presentations. CASE PRESENTATION A 4-year-old female presented with a three-month history of colicky abdominal pain. Imaging studies confirmed MSG with gallbladder sludge but no stones. Despite normal initial lab results, the patient underwent a laparoscopic cholecystectomy due to persistent symptoms, resulting in a full recovery with no complications over six months. DISCUSSION The etiology of MSG is unclear, with several embryological theories proposed. Diagnosis relies on imaging techniques like ultrasound and MRI. A literature review of 37 pediatric cases shows a higher prevalence in females and varied clinical presentations. Management includes conservative observation or surgical intervention, with cholecystectomy proving effective for symptomatic cases. CONCLUSION Multiseptate gallbladder is a rare congenital anomaly in pediatric patients, often requiring imaging techniques like MRCP for accurate diagnosis. While many cases remain asymptomatic and can be managed conservatively, surgical intervention is beneficial for those with persistent symptoms. Early diagnosis and tailored management lead to favorable outcomes.
Collapse
Affiliation(s)
- Ahmed Amgad
- Faculty of Medicine, Helwan University, Cairo, Egypt; The Research Papyrus Lab, Alexandria, Egypt; Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA.
| | | | - Ahmed K Ali
- Assiut University Children Hospital, Assiut University, Assiut, Egypt.
| | | |
Collapse
|
|
2
|
Oyachi N, Numano F, Koizumi K, Takano A, Shibusawa H. Multiseptate gallbladder coexisting with pancreaticobiliary maljunction treated by laparoscopic cholecystectomy: report of a pediatric case. Surg Case Rep 2022; 8:16. [PMID: 35061125 PMCID: PMC8782956 DOI: 10.1186/s40792-022-01370-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A multiseptate gallbladder is a very rare congenital malformation in which the lumen is divided into variously sized multiseptal compartments. The pathogenesis and natural history of this disease remain uncertain. We herein describe a pediatric case of a multiseptate gallbladder with pancreaticobiliary maljunction (PBM), which was treated by laparoscopic cholecystectomy.
Case presentation
A 5-year-old girl was referred to our hospital, because a multiseptate gallbladder had been incidentally detected on abdominal ultrasonography when she presented for transient abdominal pain. Ultrasonography showed hyperechoic septa throughout the lumen of the gallbladder, giving it a honeycomb appearance. The atrophied gallbladder had weak or no contractility. Magnetic resonance cholangiopancreatography performed to detect other coexisting biliary disorders revealed PBM without dilatation of the common bile duct. Although physical examination and laboratory tests revealed no abnormalities, we performed laparoscopic cholecystectomy to prevent cholecystitis and reduce the risk of cancer secondary to the PBM.
Conclusions
In recent pediatric case reports, the indication and timing of cholecystectomy has tended to be determined by the patient’s symptoms and the presence of biliary complications. In the present case, however, the combination of a multiseptate gallbladder and PBM may become problematic in the future. Surgical treatment without delay was appropriate even in this pediatric patient.
Collapse
|
|
3
|
Hsieh YM, Hsieh YL, Wang NL, Wu PS, Weng SC. Multiseptate gallbladder: A case report and literature review. Medicine (Baltimore) 2021; 100:e27992. [PMID: 34889244 PMCID: PMC8663827 DOI: 10.1097/md.0000000000027992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Multiseptate gallbladder (MSG) is a rare congenital gallbladder anomaly. Between 1963 and June 2021, only 56 cases were reported. There is currently no treatment guideline for pediatric or adult cases of MSG. PATIENT CONCERNS A 14-year-old woman visited our out-patient clinic in September 2020 for epigastric pain that last for 6 months. Honeycomb appearance of the gallbladder was noted under ultrasonography. DIAGNOSIS The patient was diagnosed with MSG. The diagnosis was confirmed through computed tomography and magnetic resonance cholangiopancreatography. INTERVENTIONS Cholecystectomy was performed. OUTCOMES Epigastric pain showed limited improvement after the surgery. Since she was diagnosed with gastritis at the same time, a proton-pump inhibitor was prescribed. Epigastric pain was eventually resolved. LESSONS MSG cases can undergo cholecystectomy and show good recovery without complications. However, concomitant treatment may be required to resolve in the presence of other symptoms such as epigastric pain.
Collapse
Affiliation(s)
- Yu-Min Hsieh
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| | - Yuli Lily Hsieh
- Interfaculty Initiative in Health Policy, Harvard University, Boston, MA, United States
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nien-Lu Wang
- Department of Pediatric Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Pao-Shu Wu
- Department of Pathology, MacKay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan
| |
Collapse
|
|
4
|
Terkawi RS, Qutob D, Hendaus MA. Understanding multiseptated gallbladder: A systematic analysis with a case report. JGH Open 2021; 5:988-996. [PMID: 34584965 PMCID: PMC8454487 DOI: 10.1002/jgh3.12621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022]
Abstract
Multiseptated gallbladder (MSG) (also known as “Honeycomb gallbladder”) is a rare condition that was first described by Knetsch in 1952, and there are around 150 cases described over the world. MSG has been described as a congenital anomaly in most of the cases and as acquired in a few. Moreover, the phenomenon was described with a variety of different symptoms and management. The aim of this article is to have better understanding of this condition and management approach. We are reporting a 4‐year‐old girl, who presented to Sidra Medicine, Qatar with MSG. We have also included 97 cases for review and analysis. The median age of presentation of the condition was 27 years but may present in neonates and in the elderly, while gender was not a risk factor. Abdominal pain is the most common presenting symptom, but it can present without symptoms. Certain congenital anomalies were detected in the pancreaticobiliary system in few patients with MSG. Medical treatment was reported in eight symptomatic patients, four of whom failed therapy. Cholecystectomy was performed in 40 patients, which resulted in resolutions of symptoms in 13 of them. Based on the available literature, congenital MSG is probably due to in‐pouching of gallbladder wall to its own cavity forming septa containing muscular fibers. MSG can be diagnosed solely via imaging, and ultrasound appears to be an effective and feasible mode of diagnosis. Medical treatment efficacy is not well‐known, but cholecystectomy has resulted in complete resolution in symptomatic patients.
Collapse
Affiliation(s)
- Rayan S Terkawi
- Division of General Pediatrics, Department of Pediatrics Sidra Medicine Ar-Rayyan Qatar.,Division of General Pediatrics, Department of Pediatrics Hamad Medical Corporation Doha Qatar
| | - Dua' Qutob
- Division of General Pediatrics, Department of Pediatrics Sidra Medicine Ar-Rayyan Qatar.,Division of General Pediatrics, Department of Pediatrics Hamad Medical Corporation Doha Qatar
| | - Mohamed A Hendaus
- Division of General Pediatrics, Department of Pediatrics Sidra Medicine Ar-Rayyan Qatar.,Department of Clinical Pediatrics Weill Cornell Medicine Ar-Rayyan Qatar
| |
Collapse
|
|
5
|
Hasan A, Nafie K, Aldossary MY, Ismail A, Monazea K, Baheeg M, Rady K, Elhawary R, Ibrahim AA. Unexpected histopathology results following routine examination of cholecystectomy specimens: How big and how significant? Ann Med Surg (Lond) 2020; 60:425-430. [PMID: 33251000 PMCID: PMC7677112 DOI: 10.1016/j.amsu.2020.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Routine histopathological examination (RHPE) of all gallbladder specimens is required to detect the presence of gallbladder carcinoma (GBC) or any other pathology. The work aims to study the incidence and the clinical significance of detecting unusual gallbladder findings upon the RHPE of the referred cholecystectomy specimens to a histopathology laboratory section at a referral hospital in Saudi Arabia during one year period. MATERIALS AND METHODS From May 2019 to May 2020, all histopathology reports of 444 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed and divided into two groups; usual findings and unusual findings which were reviewed blindly by two other pathology consultants. Frequencies, descriptive statistics, normality test, and correlations were run. The Interrater reliability between clinical and histopathological diagnosis was assessed statistically by kappa test. RESULTS The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 296 out of 444 total cases (66.7%), acute cholecystitis in 52 cases (11.7%), and other associated usual findings in 85 cases (19%). Three cases (0.7%) of incidental carcinomas and other three cases (0.7%) of dysplasia. Eosinophilic carcinomas were detected in two cases (0.45%), gallbladder complete septum was found in one case, and one case of Phrygian cap anomaly. All patients with gallbladder carcinoma were diagnosed incidentally during the histopathological examination. CONCLUSIONS RHPE of cholecystectomy materials are required to confirm the final diagnosis and document any other pathology. Failure to detect incidental occult carcinoma may be catastrophic, given the poor prognosis.
Collapse
Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Khalid Nafie
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | | | - Amal Ismail
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Khaled Monazea
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut branch, Egypt
| | - Mohamad Baheeg
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kamal Rady
- Department of Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Reda Elhawary
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel A. Ibrahim
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
|
6
|
Bertozzi M, Bizzarri I, Angotti R, Fusi G, Ceppi S, Di Cara G, Esposito S, Messina M, Molinaro F. Multiseptate gallbladder in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
|
7
|
|
|
8
|
Garcia‐Gonzalez B, Cuesta‐Garcia N. Multiseptate gallbladder in an African lioness (
Panthera leo
). VETERINARY RECORD CASE REPORTS 2014. [DOI: 10.1136/vetreccr-2014-000093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
|
9
|
Multiseptate gallbladder in an asymptomatic child. Case Rep Gastrointest Med 2011; 2011:470658. [PMID: 22606419 PMCID: PMC3350280 DOI: 10.1155/2011/470658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 07/21/2011] [Indexed: 12/05/2022] Open
Abstract
A one-year-old child being investigated for urinary tract infection was diagnosed with a multiseptate gallbladder. The patient remains asymptomatic, and investigations demonstrate no associated anomalies. Forty-three cases, including 13 cases in children were identified in the literature. Their presentation and management were reviewed.
Collapse
|
|
10
|
Rivera-Troche EY, Hartwig MG, Vaslef SN. Multiseptate gallbladder. J Gastrointest Surg 2009; 13:1741-3. [PMID: 19352782 DOI: 10.1007/s11605-009-0880-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 03/24/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Multiseptate gallbladder is a rare congenital condition that may be asymptomatic or may lead to symptoms consistent with biliary colic, even in the absence of cholelithiasis. DISCUSSION We present the case of a 19-year-old female who underwent an extensive gastrointestinal workup before she was referred for cholecystectomy, which led to resolution of her symptoms. The distinct imaging features of this entity are presented.
Collapse
|
|
11
|
Banerjee Jesudason SR, Raju RS. Cholecystoduodenal fistula associated with choledochal cyst: a rare clinical entity. JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2008; 15:664-666. [PMID: 18987941 DOI: 10.1007/s00534-007-1287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 10/23/2007] [Indexed: 05/27/2023]
Abstract
A 61-year-old woman presented with recent history of cholangitis. On evaluation, she was found to have a type I choledochal cyst and a cholecystoduodenal fistula. She underwent excision of the choledochal cyst and disconnection of the fistula. In this case study, we present the diagnostic features and management of choledochal cyst associated with cholecystoduodenal fistula and a literature review of the condition.
Collapse
|
|
12
|
Bahadir B, Ozdamar SO, Gun BD, Bektas S, Numanoglu KV, Kuzey GM. Ectopic pancreas associated with choledochal cyst and multiseptate gallbladder. Pediatr Dev Pathol 2006; 9:312-5. [PMID: 16944990 DOI: 10.2350/10-05-0125.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 12/31/2005] [Indexed: 11/20/2022]
Abstract
Congenital choledochal cyst is a rarely seen malformation of childhood, particularly when associated with multiseptate gallbladder or ectopic pancreas. The current case represents a 15-day-old boy with jaundice. Ultrasonography suggested a cystic lesion, probably of the common bile duct. The patient underwent a total excision of type I choledochal cyst and gallbladder with Roux-en-Y anastomosis, and a wedge biopsy from the liver. Gross examination revealed multiple septa dividing the gallbladder into multiple compartments. The outer and inner surfaces of the choledochal cyst were unremarkable. Microscopically, the cyst wall was composed of dense fibrous tissue with a single layer of cubic to columnar cells constituting the overlying epithelium. Serial sections incidentally revealed ectopic pancreatic tissue lying along the cyst wall characterized by acini, islets, and ductal structures with endocrine cells reactive for chromogranin A. Septa dividing the gallbladder were composed of fibrotic stalks containing smooth muscle fibers. Areas of papillary hyperplasia and intestinal metaplasia of gallbladder epithelium were also noted. The liver biopsy specimen demonstrated the presence of intrahepatic bile ducts, subsequently confirmed by cytokeratin 7. To our knowledge, this case represents the 1st one associated with these 3 entities and only the 2nd choledochal cyst with ectopic pancreatic tissue in its wall.
Collapse
Affiliation(s)
- Burak Bahadir
- Department of Pathology, Zonguldak Karaelmas University, Kozlu, Zonguldak, Turkey.
| | | | | | | | | | | |
Collapse
|
|
13
|
Türkvatan A, Erden A, Celik M, Olçer T. Ectopic hypoplastic and multiseptate gallbladder with coexisting choledochal cyst: evaluation with sonography and magnetic resonance cholangiopancreaticography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:88-91. [PMID: 16547984 DOI: 10.1002/jcu.20207] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Multiseptate gallbladder, a rare congenital anomaly, may exist as an isolated anomaly or may coexist with other biliary system anomalies. We report a case of a multiseptate, ectopic, hypoplastic gallbladder associated with a choledochal cyst. The diagnosis was made using sonography and magnetic resonance cholangiopancreaticography.
Collapse
Affiliation(s)
- Aysel Türkvatan
- Department of Radiology, Türkiye Yüksek Ihtisas Hospital, 06100 Sihhiye, Ankara, Turkey
| | | | | | | |
Collapse
|
|
14
|
Yamamoto T, Matsumoto J, Hashiguchi S, Yamaguchi A, Sakoda K, Taki C. Multiseptate gallbladder with anomalous pancreaticobiliary ductal union: A case report. World J Gastroenterol 2005; 11:6066-8. [PMID: 16273627 PMCID: PMC4436737 DOI: 10.3748/wjg.v11.i38.6066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multiseptate gallbladder, characterized by the presence of multiple septa dividing the gallbladder lumen, is a very extremely rare congenital anomaly of the gallbladder. On the other hand, anomalous pancreaticobiliary ductal union is also one of the congenital anomalous biliary diseases and thought to be related with choledochal cyst or biliary tract malignancies. In this paper, we describe a unique and first patient of multiseptate gallbladder with anomalous pancreaticobiliary ductal union and a review of the literature. To clarify more characters of the multiseptate gallbladder, examination of a larger patient population will be needed and further studies will be required.
Collapse
Affiliation(s)
- Takafumi Yamamoto
- Department of Endoscopy, Kagoshima University Hospital, 8-35-1 Sakuragaoka Kagoshima City, Kagoshima 890-8520, Japan.
| | | | | | | | | | | |
Collapse
|
|
15
|
Nakazawa T, Ohara H, Sano H, Kobayashi S, Nomura T, Joh T, Itoh M. Multiseptate gallbladder: diagnostic value of MR cholangiography and ultrasonography. ACTA ACUST UNITED AC 2004; 29:691-3. [PMID: 15185027 DOI: 10.1007/s00261-004-0184-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Accepted: 01/21/2004] [Indexed: 11/30/2022]
Abstract
Multiseptate gallbladder is a rare congenital malformation. We present a case that emphasizes the importance of ultrasonography and magnetic resonance imaging. Ultrasound examination of the abdomen showed multiple linear internal echoes consistent with multiple septa crossing the entire gallbladder lumen, creating a honeycomb appearance. Magnetic resonance cholangiopancreatography showed a grapelike cluster of the whole gallbladder.
Collapse
Affiliation(s)
- T Nakazawa
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Abstract
Multiseptate gall-bladder is a very rare congenital condition, and fewer than 30 cases are reported in the literature. Most patients are female adults though it can occur in children and men. Although usually symptomatic, a case is described of a patient diagnosed incidentally on ultrasound. In the former group it is important to recognize because cholecystectomy is curative. Biliary calculi are usually absent in multiseptate gall-bladder while choledochal cysts have been associated.
Collapse
Affiliation(s)
- D Saddik
- Department of Diagnostic Imaging, Princess Margaret Hospital for Children, Subiaco, Australia
| |
Collapse
|
|
17
|
Affiliation(s)
- M L Paciorek
- Department of Radiology, St. Francis Medical Center, Pittsburgh, Pennsylvania 15201, USA
| | | | | | | |
Collapse
|
|
18
|
Stringer MD, Dhawan A, Davenport M, Mieli-Vergani G, Mowat AP, Howard ER. Choledochal cysts: lessons from a 20 year experience. Arch Dis Child 1995; 73:528-31. [PMID: 8546511 PMCID: PMC1511455 DOI: 10.1136/adc.73.6.528] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic dilatation of the biliary tree is a rare congenital anomaly. To determine mode of presentation, diagnostic pitfalls, and long term outcome after surgery, 78 children (57 girls, 21 boys) with choledochal cyst treated between 1974 and 1994 were reviewed. Anatomical types were: Ic (n = 44), If (n = 28), IVa (n = 4), and V (n = 2); a common pancreaticobiliary channel was identified in 76% patients. Age at presentation ranged from 0-16 (median 2.2) years, six patients being diagnosed by prenatal ultrasonography. Of the 72 patients diagnosed postnatally, 50 (69%) presented with jaundice, associated with abdominal pain in 25 or a palpable mass in three, 13 (18%) presented with pain alone, and two (3%) with a palpable mass. The classic triad of jaundice, pain, and a right hypochondrial mass was present in only four (6%). Four children presented acutely after spontaneous perforation of a choledochal cyst, two presented with ascites and one cyst was discovered incidentally. Plasma and/or biliary amylase values were raised in 30 of 31 patients investigated for abdominal pain; seven had evidence of pancreatitis at operation. In 35 of 67 (52%) patients referred without previous surgery, symptoms had been present for more than one month, and in 14 of them for more than one year, before diagnosis. Delayed referral was due to misdiagnosis as hepatitis (n = 12), incomplete investigation of abdominal pain (n = 6), and failure to note the significance of ultrasonographic findings (n = 10). Two patients referred late died from liver failure. Of the 76 patients with type I or IV cysts, 59 underwent radical cyst excision and hepaticojejunostomy as a primary procedure and 10 as a secondary operation after previously unsuccessful surgery. Sixteen patients have been lost to follow up but most of the remainder are well after a mean period of 4.1 (0.1-13) years. Choledochal cysts are often misdiagnosed, but prognosis is excellent if radical excision is performed.
Collapse
Affiliation(s)
- M D Stringer
- Department of Surgery, King's College Hospital, London
| | | | | | | | | | | |
Collapse
|
|
19
|
Hahm KB, Yim DS, Kang JK, Park IS. Cholangiographic appearance of multiseptate gallbladder: case report and a review of the literature. J Gastroenterol 1994; 29:665-8. [PMID: 8000519 DOI: 10.1007/bf02365454] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of multiseptate gallbladder is described, with a review of the literature. This is the 24th such case report. The patient complained of right upper quadrant pain, colicky in nature. Abdominal ultrasonography showed multiple fine echoes within the gallbladder. On endoscopic retrograde cholangiography, multiple radiolucent lines crossing the gallbladder in various directions were noted within the gallbladder. The gallbladder was crisscrossed by numerous delicate septations and had a honeycomb appearance. These findings suggested multiseptate gallbladder.
Collapse
Affiliation(s)
- K B Hahm
- Department of Internal Medicine, Yonsei University School of Medicine, Inchon City, Korea
| | | | | | | |
Collapse
|