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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

EUS showing a 21.3 x 17.2 mm hypoechoic mass at the superior surface of the neck of pancreas.
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Figure 4: EUS showing a 21.3 x 17.2 mm hypoechoic mass at the superior surface of the neck of pancreas.

Mentions: A 78-year-old woman presented with pruritus, jaundice, and dark urine for 1 month. LFTs were consistent with obstructive jaundice. Abdominal CT showed diffuse bile duct dilatation. Further evaluation by MRCP showed diffuse bile duct dilatation to the level below the cystic duct take off. No stones were identified. Prior ERCP had shown a distal CBD stricture that was dilated and stented with a 10 French x 5 cm plastic stent. Brush cytology was negative. The patient's jaundice persisted, and endoscopic ultrasound showed a hypoechoic mass of 21.3 x 17.2 mm at the superior surface of the neck of pancreas (Figure 4). Fine-needle aspiration revealed moderately differentiated adenocarcinoma cells consistent cholangiocarcinoma. The old stent was removed. Repeat ERCP showed type Va extrahepatic bile duct duplication. The cystic duct was communicating with the right main extrahepatic duct. The biliary hilum was obstructed by the mass mimicking a Klatskin tumor (Figure 5). The biliary strictures were dilated and 2 plastic stents were placed up to the right and left main extrahepatic bile ducts (Figure 5).


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)

EUS showing a 21.3 x 17.2 mm hypoechoic mass at the superior surface of the neck of pancreas.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: EUS showing a 21.3 x 17.2 mm hypoechoic mass at the superior surface of the neck of pancreas.
Mentions: A 78-year-old woman presented with pruritus, jaundice, and dark urine for 1 month. LFTs were consistent with obstructive jaundice. Abdominal CT showed diffuse bile duct dilatation. Further evaluation by MRCP showed diffuse bile duct dilatation to the level below the cystic duct take off. No stones were identified. Prior ERCP had shown a distal CBD stricture that was dilated and stented with a 10 French x 5 cm plastic stent. Brush cytology was negative. The patient's jaundice persisted, and endoscopic ultrasound showed a hypoechoic mass of 21.3 x 17.2 mm at the superior surface of the neck of pancreas (Figure 4). Fine-needle aspiration revealed moderately differentiated adenocarcinoma cells consistent cholangiocarcinoma. The old stent was removed. Repeat ERCP showed type Va extrahepatic bile duct duplication. The cystic duct was communicating with the right main extrahepatic duct. The biliary hilum was obstructed by the mass mimicking a Klatskin tumor (Figure 5). The biliary strictures were dilated and 2 plastic stents were placed up to the right and left main extrahepatic bile ducts (Figure 5).

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