Choledochal cyst
Introduction
Introduction to choledochal cyst Choledochal cyst (CC) is a common congenital biliary tract disease in children. It is mainly characterized by abdominal pain, abdominal mass and jaundice. Once the disease is diagnosed, early surgery is needed to reduce biliary cirrhosis caused by biliary infection and obstructive jaundice. Cystectomy, hepaticojejunal Roux-Y anastomosis is the current standard procedure for the treatment of choledochal cysts. Due to laparoscopic cystectomy and total jejunal Roux-Y anastomosis for biliary reconstruction, the surgical trauma is small, the child recovers quickly, and the drainage can be achieved. The enlarged surgical field under the microscope is conducive to precise surgical operation and becomes gradually becoming Clinically used surgical methods for the treatment of pediatric choledochal cysts. There are different clinical manifestations at different ages of onset, and neonates and young children usually present with abdominal masses, obstructive jaundice, and white stools. Some show a huge mass in the abdomen without jaundice. Older children usually present with typical triads, namely abdominal pain, abdominal masses and jaundice, with abdominal pain as the main cause, and fever and vomiting also occur. In adult cases, the degree of general dilatation of the common bile duct is mild, mainly manifested as abdominal pain and chronic gallbladder inflammation. basic knowledge The proportion of illness: this disease is rare, the incidence rate is about 0.0001% - 0.0002% Susceptible people: more common in children Mode of infection: non-infectious Complications: pancreatitis
Cause
Causes of choledochal cyst
The degree of pain is different (30%):
The nature and degree of pain in the recurrent right upper abdomen or upper abdomen are different, sometimes it is colic pain or slight pain. Secondary infection may be accompanied by fever, sometimes nausea and abdominal pain account for about 80% to 90%.
Infection (20%):
Generally, the recurrence of multiple infections and fever are mostly intermittent episodes. Because the distal end of the common bile duct is not fluent, the biliary tract infection appears. The symptoms of the symptoms are relieved or disappeared after a few days of treatment. Frequent seizures in children may occur in a few months. In addition to the above symptoms, there may be nausea, vomiting, jaundice, white clay-like stools, and dark urine. Individuals, especially infants, have cystic perforation. Causes acute biliary peritonitis, high fever, bloating and even shock.
Prevention
Prevention of choledochal cyst
A reasonable diet can take more high-fiber and fresh vegetables and fruits, balanced nutrition, including essential nutrients such as protein, sugar, fat, vitamins, trace elements and dietary fiber, with a combination of vegetarian and vegetarian foods. The complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Common bile duct cyst complications Complications pancreatitis
For the choledochal cyst found before birth, once found, you should seek medical advice immediately after birth. Because of the premature choledochal cyst, it is easy to cause progressive liver injury. If it is not treated, it will eventually lead to cirrhosis. For children with choledochal cyst, surgery should be performed in time. Long-term choledochal cyst can easily lead to biliary obstruction. Liver damage, and biliary obstruction can cause biliary pancreatitis. Long-term inflammation of the biliary tract is also easy to increase the difficulty of surgery, leading to postoperative complications.
Symptom
Symptoms of common bile duct cysts Common symptoms Gray stools, upper abdomen, abdominal pain, bile duct obstruction, jaundice
There are different clinical manifestations at different ages of onset, and neonates and young children usually present with abdominal masses, obstructive jaundice, and white stools. Some show a huge mass in the abdomen without jaundice. Older children usually present with typical triads, namely abdominal pain, abdominal masses and jaundice, with abdominal pain as the main cause, and fever and vomiting also occur. In adult cases, the degree of general dilatation of the common bile duct is mild, mainly manifested as abdominal pain and chronic gallbladder inflammation.
Examine
Examination of choledochal cyst
1. X-ray examination: the upper abdomen plain film can be seen with a dense mass shadow, gastrointestinal X-ray barium angiography or low-profile duodenal angiography, showing that the stomach is pressed to the left front shift, the duodenum is moved to the left front and bottom. Position, duodenal curvature increases. X-ray barium enema examination showed that the colonic hepatic flexion was shifted forward and downward. Cholecystography often fails When serum bilirubin is greater than 3 mg/dl, there is no development by oral or venography, and intravenous cholangiography may be valuable only before jaundice is present.
2. Ultrasonic examination: A constant liquid level section can be found. The tomograph can reliably show the location and size of the abdominal cavity cyst. Liver radionuclide scanning helps identify intrahepatic bile duct conditions and the location and size of the common bile duct cyst. Selective celiac angiography showed a large area of avascular area suggesting the location of the cyst.
Diagnosis
Diagnosis and differentiation of choledochal cyst
diagnosis
According to the child's early onset of typical abdominal pain, jaundice, abdominal mass and large symptoms should consider this disease, but some do not have large symptoms, need to be combined with laboratory examination, abdominal ultrasound, CT and cholangiography to make a diagnosis .
Differential diagnosis
The main manifestation of jaundice should be differentiated from jaundice hepatitis, common bile duct atresia, and hemolytic jaundice. The main manifestations of abdominal mass should be differentiated from common retroperitoneal and intraperitoneal tumors in children, such as hydronephrosis. Renal embryonal tumor, teratoma, liver tumor, mesentery and omental cyst, etc., with abdominal pain need to be differentiated from intussusception, intestinal diverticulum, biliary tract mites, cholecystitis, intrahepatic biliary cyst should be differentiated from congenital hepatic cyst .
