Yusuf Sulaiman, Nuriyanto Alivia R, Nadia Nurul, Muntadhar Muntadhar, Muzakkir Yumna, Susanti Nurhayani D, Al-Shather Zain, Harrika Fenny
Departement of Pediatric, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
Departement of Pediatric, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia.
Narra J. 2023 Aug;3(2):e201. doi: 10.52225/narra.v3i2.201. Epub 2023 Aug 28.
A choledochal cyst is a bile duct anomaly that disrupts the transportation of bile from the liver to the gallbladder and small intestine. Choledochal cysts are rare, occurring in approximately one out of every 100,000 to 150,000 children in Western countries, with a girls-to-boys ratio of 4:1. Immediate surgery to excise the cyst and construct a biliary-enteric continuity is necessary to treat this condition. This case-report aimed to present a child with choledochal cyst type IVa who underwent a Roux-en-Y hepaticojejunostomy. A 3-year-11-month-old girl with an abdominal mass experienced jaundice, nausea, and vomiting over the past two years, which worsened in the last month. Abdominal ultrasonography indicated intrahepatic biliary dilatation. Abdominal computed tomography scan results confirmed a choledochal cyst type IVa, characterized by fusiform cyst dilatation at the bilateral intrahepatic bile duct, common hepatic duct, cystic duct, and common bile duct. The cyst exerted pressure on the pancreas and small intestine. Before the surgery, the patient was treated with ceftriaxone 100 mg/kg/day and gentamicin 5 mg/kg/day. Roux-en-Y hepaticojejunostomy was performed, involving the complete excision of the extrahepatic bile duct to reconstruct the biliary system. During the surgery, a retroperitoneal cyst measuring 20 cm x 10 cm with a volume of 200 ml was discovered. Following the surgery, the patient showed clinical improvement. Patient follow-ups indicated that no complications such as wound infection, acute pancreatitis, and the formation of pancreatic or biliary fistula occurred. This case highlights that Roux-en-Y hepaticojejunostomy proves to be an effective surgical approach for managing choledochal cyst type IVa in children, helping to prevent further complications.
胆总管囊肿是一种胆管异常疾病，会干扰胆汁从肝脏向胆囊和小肠的输送。胆总管囊肿较为罕见，在西方国家，每10万至15万名儿童中约有1人患病，女孩与男孩的患病比例为4:1。对于这种疾病，必须立即进行手术切除囊肿并构建胆道与肠道的连续性。本病例报告旨在介绍一名接受了Roux-en-Y肝空肠吻合术的IVa型胆总管囊肿患儿。一名3岁11个月大的女童腹部有肿块，在过去两年中出现黄疸、恶心和呕吐症状，且在最后一个月病情加重。腹部超声检查显示肝内胆管扩张。腹部计算机断层扫描结果证实为IVa型胆总管囊肿，其特征为双侧肝内胆管、肝总管、胆囊管和胆总管呈梭形囊肿扩张。囊肿对胰腺和小肠施加了压力。手术前，患者接受了每日100mg/kg的头孢曲松和每日5mg/kg的庆大霉素治疗。实施了Roux-en-Y肝空肠吻合术，包括完全切除肝外胆管以重建胆道系统。手术过程中，发现一个位于腹膜后的囊肿，大小为20cm×10cm，体积为200ml。手术后，患者的临床症状有所改善。对患者的随访表明，未发生伤口感染、急性胰腺炎以及胰腺或胆瘘形成等并发症。本病例突出表明，Roux-en-Y肝空肠吻合术被证明是治疗儿童IVa型胆总管囊肿的一种有效手术方法，有助于预防进一步的并发症。
