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胆总管囊肿——成人期的不寻常表现:病例报告

Choledochal cyst- unusual presentation in the adult phase: Case report.

作者信息

de Albuquerque Victor Vinicius Monteiro Lins, De Macedo Frank Pinheiro, Costa Ketlen G, Rodrigues Seixas Nunes Zuriel, da Silva Junior Rubem A

机构信息

Digestive System Surgery Service at Getúlio Vargas Teaching Hospital (HUGV), Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil.

General Surgery Service at Getúlio Vargas Teaching Hospital (HUGV), Avenida Apurinã, 4 - Praça 14 de Janeiro, Manaus, Amazonas, 69020-170, Brazil.

出版信息

Int J Surg Case Rep. 2020;70:33-36. doi: 10.1016/j.ijscr.2020.03.014. Epub 2020 Apr 2.

Abstract

INTRODUCTION

Bile duct cysts are congenital malformations characterized by bile duct dilatation with intra and/or extrahepatic localization. About 80% of cases are diagnosed in childhood, so their presentation in adults is rare and repeatedly associated with complications.

PRESENTATION OF CASE

A 38-year-old female patient complained of severe abdominal pain for one month, with no associated cholestatic signs. She underwent abdominal ultrasonography that showed cholelithiasis with extrahepatic bile duct dilatation and underwent cholangiography (MRI), which revealed fusiform dilatation of the proximal portion of the hepatocholedochal, compatible with choledochal cyst.

DISCUSSION

In adult patients, clinical manifestations are usually nonspecific, and the diagnosis is established by medical imaging. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard diagnostic today. Treatment with better prognosis consists of total cyst resection with hepaticojejunal anastomosis and intestinal transit reconstruction with Roux-en-Y.

CONCLUSION

Bile duct cysts are a rare condition in adults. Currently, increasing access to more accurate medical imaging enables early diagnosis, contributing to the use of therapeutic methods in appropriate time, avoiding development of complications.

摘要

引言

胆管囊肿是一种先天性畸形,其特征为胆管扩张,可位于肝内和/或肝外。约80%的病例在儿童期被诊断出来,因此其在成人中的表现较为罕见,且常伴有并发症。

病例介绍

一名38岁女性患者主诉严重腹痛1个月,无相关胆汁淤积体征。她接受了腹部超声检查,结果显示有胆结石伴肝外胆管扩张,随后接受了胆管造影(磁共振成像),结果显示肝总管近端呈梭形扩张,符合胆管囊肿表现。

讨论

在成年患者中,临床表现通常不具有特异性,诊断需依靠医学影像学检查。磁共振胰胆管造影(MRCP)是目前的金标准诊断方法。预后较好的治疗方法是行囊肿全切术并进行肝空肠吻合,以及采用Roux-en-Y术式重建肠道通路。

结论

胆管囊肿在成人中较为罕见。目前,越来越容易获得更精确的医学影像检查,这有助于早期诊断,促使在适当的时候采用治疗方法,避免并发症的发生。

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