Saluja Sundeep Singh, Mishra Pramod Kumar, Nayeem Mohammed, Nag Hridya Hulas
Department of Gastrointestinal Surgery, GB Pant Hospital, New Delhi, India.
JOP. 2010 Nov 9;11(6):601-3.
Choledochal cysts are benign congenital cystic dilatations of the common bile duct. They are usually associated with pancreatobiliary malunion resulting in long-term complications, such as acute pancreatitis and bile duct cancer. However, the occurrence of chronic pancreatitis with a choledochal cyst is rarely reported.
We report three cases of choledochal cysts associated with chronic pancreatitis with their presentation and management. The choledochal cysts were classified according to the Alonso-Lej classification with Todani modifications, based on radiographic and operative findings. Chronic pancreatitis was defined using Marseille criteria (1984). Two patients had a type I choledochal cyst and one had a type IV-A. All cases had chronic calcific pancreatitis with a grossly dilated main pancreatic duct. Abdominal pain was the most common presentation, present in all three patients while jaundice was seen in one patient. The laboratory parameters and MRI/MRCP helped to confirm the diagnosis. All patients underwent cyst excision with drainage and had an uneventful postoperative course. At a median follow-up of 9 months, two patients were asymptomatic and one patient, who developed duodenal obstruction, underwent gastrojejunostomy.
the association of a choledochal cyst with chronic pancreatitis may be etiologically related. Excision of the cyst with lateral pancreaticojejunostomy can be performed safely and is usually curative.
胆总管囊肿是胆总管的先天性良性囊性扩张。它们通常与胰胆管汇合异常相关，可导致长期并发症，如急性胰腺炎和胆管癌。然而，胆总管囊肿合并慢性胰腺炎的情况鲜有报道。
我们报告3例胆总管囊肿合并慢性胰腺炎的病例及其临床表现和治疗情况。根据影像学和手术结果，按照Alonso-Lej分类法并经Todani修正对胆总管囊肿进行分类。采用马赛标准（1984年）定义慢性胰腺炎。2例患者为I型胆总管囊肿，1例为IV-A型。所有病例均为慢性钙化性胰腺炎，主胰管明显扩张。腹痛是最常见的表现，3例患者均有腹痛，1例患者出现黄疸。实验室检查参数及磁共振成像/磁共振胰胆管造影有助于确诊。所有患者均接受囊肿切除及引流术，术后恢复顺利。中位随访9个月时，2例患者无症状，1例出现十二指肠梗阻的患者接受了胃空肠吻合术。
胆总管囊肿与慢性胰腺炎的关联可能存在病因学联系。囊肿切除联合胰管空肠侧侧吻合术可安全实施，且通常可治愈。
