The Second Affiliated Hospital of Soochow University, Suzhou, China.
Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China.
BMC Gastroenterol. 2022 May 4;22(1):220. doi: 10.1186/s12876-022-02278-x.
Biliary dilatation is a rare disease involving intrahepatic and extrahepatic biliary tract abnormalities. With the development of imaging technology, an increasing number of special cases have been diagnosed, which poses a challenge to the traditional classification method.
A 50-year-old woman was admitted to the hospital due to right upper quadrant pain for more than 10 days. The patient had previous episodes of similar symptoms, which were relieved after symptomatic treatment at a local community hospital. After the symptoms developed, she underwent a computed tomography scan at the local hospital, which showed biliary dilatation; thus, she was referred to our hospital for further treatment. After admission, her magnetic resonance imaging examination also suggested biliary dilatation, but abnormal signals were found in her duodenum. First, a duodenal diverticulum was considered. Later, endoscopic ultrasonography was conducted, and the results suggested that the dilated biliary tract had herniated into the duodenum. This type of lesion is most closely classified as a Todani type III lesion. The patient finally underwent choledochectomy and Roux‑en‑Y hepaticojejunostomy, and the postoperative pathology was consistent with our preoperative diagnosis. The patient was followed up for approximately 2 years, and no obvious postoperative complications were found.
The manifestations of this case are relatively rare and involve one of the undiscussed categories of the Todani classification system; therefore, this case has certain clinical value. Moreover, there is no report similar to this experience in the previous literature.
胆系扩张是一种罕见疾病，涉及肝内和肝外胆管异常。随着影像学技术的发展，越来越多的特殊病例被诊断出来，这对传统的分类方法提出了挑战。
一名 50 岁女性因右上腹疼痛超过 10 天而入院。该患者曾有类似症状发作，在当地社区医院接受对症治疗后症状缓解。症状发作后，她在当地医院行计算机断层扫描检查，显示胆系扩张；因此，她被转至我院进一步治疗。入院后，其磁共振成像检查也提示胆系扩张，但在十二指肠发现异常信号。首先考虑十二指肠憩室。后来进行了内镜超声检查，结果提示扩张的胆管疝入十二指肠。这种病变类型最接近 Todani Ⅲ型病变。患者最终接受了胆总管切除术和 Roux-en-Y 肝肠吻合术，术后病理与术前诊断一致。患者随访约 2 年，未发现明显术后并发症。
本例表现较为罕见，涉及 Todani 分类系统中未讨论的类别之一，因此具有一定的临床价值。此外，既往文献中尚无类似的报道。
