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Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy.

Hammad TA, Alastal Y, Khan MA, Hammad M, Alaradi O, Nigam A, Sodeman TC, Nawras A - ACG Case Rep J (2015)

Bottom Line: We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor).We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.

ABSTRACT
We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

No MeSH data available.


Related in: MedlinePlus

Diagram of type V extrahepatic bile duct duplication. Type Va consists of 2 separate extrahepatic bile ducts with single biliary drainage (black arrow) to the duodenum. Type Vb consists of 2 extrahepatic bile ducts with communicating channel (red arrow) and single biliary drainage (black arrow) to the duodenum.
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Figure 2: Diagram of type V extrahepatic bile duct duplication. Type Va consists of 2 separate extrahepatic bile ducts with single biliary drainage (black arrow) to the duodenum. Type Vb consists of 2 extrahepatic bile ducts with communicating channel (red arrow) and single biliary drainage (black arrow) to the duodenum.

Mentions: A 77-year-old woman presented with jaundice and a 9-kg weight loss. Abdominal computed tomography (CT) revealed diffuse bile duct dilatation. No pancreatic mass was seen. Magnetic resonance cholangiopancreatography (MRCP) showed diffuse bile duct dilatation and a stone in the extrahepatic duct with questionable distal common bile duct (CBD) stricture. The pancreatic duct was normal. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted at a community hospital, which reported diffuse bile duct dilatation. The procedure was aborted due to suspected contrast extravasation from the biliary tree, and the patient was transferred to our facility for further evaluation. Liver function tests (LFTs) were consistent with obstructive jaundice. Repeated ERCP revealed extrahepatic bile duct duplication with single biliary drainage to the duodenum (Figure 1). The cystic duct was communicating with the right main extrahepatic duct. These findings were consistent with type Va extrahepatic bile duct duplication (Figure 2). The right and left main extrahepatic bile ducts were markedly dilated (25 mm and 15 mm, respectively) with a stone in the left duct (Figure 1). Brushing cytology of the CBD and main extrahepatic bile ducts revealed adenocarcinoma cells suggestive of a cholangiocarcinoma. Two plastic stents were placed up to the right and left main extrahepatic bile ducts (Figure 3).


Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy.

Hammad TA, Alastal Y, Khan MA, Hammad M, Alaradi O, Nigam A, Sodeman TC, Nawras A - ACG Case Rep J (2015)

Diagram of type V extrahepatic bile duct duplication. Type Va consists of 2 separate extrahepatic bile ducts with single biliary drainage (black arrow) to the duodenum. Type Vb consists of 2 extrahepatic bile ducts with communicating channel (red arrow) and single biliary drainage (black arrow) to the duodenum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612759&req=5

Figure 2: Diagram of type V extrahepatic bile duct duplication. Type Va consists of 2 separate extrahepatic bile ducts with single biliary drainage (black arrow) to the duodenum. Type Vb consists of 2 extrahepatic bile ducts with communicating channel (red arrow) and single biliary drainage (black arrow) to the duodenum.
Mentions: A 77-year-old woman presented with jaundice and a 9-kg weight loss. Abdominal computed tomography (CT) revealed diffuse bile duct dilatation. No pancreatic mass was seen. Magnetic resonance cholangiopancreatography (MRCP) showed diffuse bile duct dilatation and a stone in the extrahepatic duct with questionable distal common bile duct (CBD) stricture. The pancreatic duct was normal. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted at a community hospital, which reported diffuse bile duct dilatation. The procedure was aborted due to suspected contrast extravasation from the biliary tree, and the patient was transferred to our facility for further evaluation. Liver function tests (LFTs) were consistent with obstructive jaundice. Repeated ERCP revealed extrahepatic bile duct duplication with single biliary drainage to the duodenum (Figure 1). The cystic duct was communicating with the right main extrahepatic duct. These findings were consistent with type Va extrahepatic bile duct duplication (Figure 2). The right and left main extrahepatic bile ducts were markedly dilated (25 mm and 15 mm, respectively) with a stone in the left duct (Figure 1). Brushing cytology of the CBD and main extrahepatic bile ducts revealed adenocarcinoma cells suggestive of a cholangiocarcinoma. Two plastic stents were placed up to the right and left main extrahepatic bile ducts (Figure 3).

Bottom Line: We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor).We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH.

ABSTRACT
We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

No MeSH data available.


Related in: MedlinePlus