Bai Yufan, Li Chunmei, Tang Jihong, He Min
Department of Hepato-Biliary-Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
J Surg Case Rep. 2023 Dec 19;2023(12):rjad545. doi: 10.1093/jscr/rjad545. eCollection 2023 Dec.
A 53-year-old male patient with a previous diagnosis of dilatation of the common bile duct was admitted to the hospital due to recurrent episodes of vague epigastric pain over a 4-month period. After undergoing abdominal CT, MRI, MRCP, ERCP examinations, together with joint diagnosis by the radiology department and the gastroscopy unit, the diagnosis of a cystic dilatation of the common bile duct was excluded, and to preliminarily diagnose as cystic lesion at the hepatoduodenum ligament. A nasobiliary tube was preset before the surgery, and it was found that the gallbladder, the cyst, and the common bile duct were connected in sequence during the surgery, leading to the definitive diagnosis of biliary cyst of the cystic duct. During the surgery, the anatomical position of the common bile duct was accurately identified, avoiding iatrogenic biliary injury and preserving the integrity of the common bile duct structure. The patient recovered and was discharged from the hospital on the 14th postoperative day. Cystic duct cysts are a relatively new and rare condition. This case demonstrates that clinical decision-making by a multidisciplinary team is of great significance for such diseases, and preoperative assessment of the anatomical relationship between cystic dilation lesions in the hepatic portal region and the biliary system and gallbladder is also crucial.
一名53岁男性患者，既往诊断为胆总管扩张，因4个月来反复出现上腹部隐痛入院。在接受腹部CT、MRI、MRCP、ERCP检查，并经放射科和胃镜室联合诊断后，排除了胆总管囊性扩张的诊断，初步诊断为肝十二指肠韧带囊性病变。术前预置了鼻胆管，术中发现胆囊、囊肿和胆总管依次相连，最终确诊为胆囊管囊肿。手术过程中准确识别了胆总管的解剖位置，避免了医源性胆管损伤，保留了胆总管结构的完整性。患者术后恢复良好，于术后第14天出院。胆囊管囊肿是一种相对较新的罕见疾病。该病例表明，多学科团队的临床决策对于此类疾病具有重要意义，术前评估肝门区囊性扩张病变与胆道系统及胆囊之间的解剖关系也至关重要。
