Ana Laura Hernández BarragánWomen's Hospital belonging to the Health Secretariat, Mexico
Title: Giant choledochal cyst. Case report
Introduction: Choledochal cysts are congenital dilatations of the bile duct when they measure more than 10 centimetres are considered large. They are 1% of the benign cysts disorders. 80% is presented in schoolchildren and is presented more in women (4:1). These are abnormalities of the development of hepatic diverticulum which are responsible of abnormal connection of the pancreaticobiliary ducts. Infants over the age of 1 year present clinically abdominal mass and abdominal pain. The classical triad is presented by 22% with jaundice, dolor abdominal and palpable lump. According to the location, the classification of Todani is divided in five types. Ultrasound is the imaging study, however, magnetic resonance cholangiopancreatography visualizes the anatomy of the bile duct and the pancreaticobiliary junction and dismiss vascular disorder. The only treatment with a successful resolution with 90% is surgery. The most commonly used technique is cystectomy with Roux-en-Y hepatic jejunoanastomosis
Clinical case: 12-year-old female with a history of appendectomy and hepatitis A with multiple drug treatments with suspected of colitis and gastritis. She began with a 5-day history of predominantly epigastric abdominal pain, without irrradiation, burning, transflictive, progressive increase accompanied with jaundice, coluria, and constipation. She received pharmacological management presenting a partial recovery. After 72 hours, he presented nausea and vomiting. On physical examination, she presented a painful upon deep palpation in the epigastrium and under the right costal margin, with no evidence of peritoneal irritation. Report of laboratory studies suggestive of cholangitis and cholangioresonance with choledochal cyst (6.9 x 3 x 2.7 cm). She required resection and anastomosis of the hepatic duct with the duodenum by exploratory laparotomy, finding a Todani type I large choledochal cyst (10 x 15 cm). During postsurgical, she had an adequate evolution and follow-up without complications. Discussions and conclusions This pathology increases to 30% the risk of biliary malignancy (cholangiocarcinoma), so careful observation of clinical signs and symptoms could lead a timely diagnosis and an early treatment. The previous one helps to facilitate a surgical correction and reduce the risk of complications.
Ana Laura Hernández Barragán completed her bachelor's degree in General Medicine at the Naval Medical School that belongs to the Secretary of the Navy-Mexican Navy in 2012. She finished her specialty in Pediatrics at the Postgraduate School of Naval Health belonging to the Secretary of the Navy-Mexican Navy in 2019. She is currently a resident of the Sub-specialty in Neonatology at the Women's Hospital belonging to the Health Secretariat, in Mexico City. She joined the Mexican Society of Pediatrics in 2020. During his professional practice, she has participated as an assistant in several courses and conferences, obtaining 2nd place in the category of Clinical Cases (poster presentation) called: "Intensive management of pediatric patients with crush syndrome due to earthquake of September 19, 2017 ” during the XIV National Congress of Pediatric Intensive Care, in 2018, in the city of Guadalajara, Jalisco, Mexico. So far, she has collaborated with publications for the International Journal of Advanced Multidisciplinary Research (IJAMR) named “Carcinoid tumor of the appendix in pediatrics. Literature review about a case”, in 2018 and with the Mexican Journal of Pediatrics called “Giant choledochal cyst. Case report”, in 2019.