Complicated choledochal cysts

Choledochal cysts have a potential for causing a variety of complications. This article presents the incidence, types, and presentation of complications in patients with choledochal cysts and the results of surgery in these patients. Prospectively collected data of 81 patients with choledochal cysts treated at a tertiary care center were retrospectively analyzed. Sixteen (20% of surgical patients; 100% of study group) patients were found to have a complicated choledochal cyst that either manifested as an atypical presentation or necessitated a change in the treatment planning. Eight (50%) of these patients had complications of infective nature, and another 8 (50%) had noninfective complications. Fifteen (94%) patients with complications were adults and 11 (63%) patients had Todani type-IVa cysts; a cystic type of intrahepatic component in 10 patients. Five (31%) patients had undergone prior cystenteric drainage operations. Excision of the choledochal cyst was possible in 14 (88%) patients under both emergency and elective situations; cyst excision was performed in the second stage after an initial external drainage procedure in two of these patients. There was no mortality and no major postoperative complications. Complications of choledochal cysts are more likely in adult patients and in those with both intra- and extrahepatic cysts (Todani type-IVa). Despite the presence of complications, the choledochal cyst can be safely excised in a majority of patients.     

Bleeding solitary renal cysts

In some current textbooks it is suggested that benign renal cysts do not bleed. However,our findings, as well as the contemporary literature, indicate that benign solitary cysts, with some degree of hematuria, are seen with relative frequency.     

Symptomatic solitary nonparasitic liver cysts

Symptomatic solitary nonparasitic liver cysts are rare, and are treated by aspiration, deroofing or total resection. We present two recent cases of women with very large such cysts, who were successfully treated by conventional deroofing and omentoplasty, since that is in our vision the treatment of choice for this benign pathology.     

Zonography in solitary bone cysts]

The zonography method is gaining more and more users today and arouses a definite interest of specialists in medicine. This is due to the peculiarities of the method and the tremendous clinical possibilities which make it possible to improve and accelerate the diagnosis not only of diseases of the lungs and kidneys, but also of some segments of the bone system. The availability of zonography allows it to be used successfully in the diagnosis of various, pathological among others, types of bone fractures, tumors of the skeleton and, therefore, makes it possible to watch the reparative manifestations and the development of the process. Radio-sonographic comparisons of long tubular bones and large joints in 2,500 cases made it possible to reveal in 15 patients, aged from 17 to 80 years, solitary rarely encountered bone cysts not complicated by fractures. Their existence was suspected due to scrupulous collection of the medical history with consideration for the localization of the pain syndrome, in the absence of abnormalities in the blood and urinary tests. A fine, ++non-ectatic, regularly sclerosed capsule was seen in the 15 cases, the septa between the cavities were clearly contrasted and demonstrated better than on ordinary radiographs, and there were no infractions or pathological fractures.     

Multiple intrahepatic biliary cysts in children with biliary atresia

Purpose: The aim of this study was to investigate the incidence, clinical course, and outcome of multiple intrahepatic biliary cysts in patients with biliary atresia. Methods: From 1992 to 2000, 154 patients with biliary atresia were examined for intrahepatic cysts. They were followed and examined routinely using abdominal ultrasonography. Results: Twenty-three patients had single intrahepatic cysts, and 16 patients had multiple cysts. The incidence of intrahepatic cysts in these patients were 25.3% (39 of 154) for all kinds of cysts and 10.4% (16 of 154) for multiple intrahepatic cysts. Of the 16 patients with multiple cysts, 13 (81.3%) had jaundice, and 15 (93.8%) had a history of cholangitis before cysts were detected. Image studies showed multiple discrete ovoid or round intrahepatic biliary cysts with various sizes along the biliary trees. The cysts decreased in size or number in 7 patients after antibiotic treatment and disappeared in only one patient. The mortality rate was higher in patients with multiple cysts than in those with single cysts (P = .037). Conclusions: Multiple intrahepatic biliary cysts are a common complication in patients with biliary atresia and suggests a poor prognosis. Prolonged parenteral antibiotics treatment should be administered when signs of biliary infection appear. J Pediatr Surg 37:1183-1187.     

Calcaneal solitary bone cysts in children]

The purpose of our study was to analyze the final results of the treatment of calcanear solitary bone cyst in children and standardize management on the basis our material. We assessed retrospectively the case notes, radiographs and pathologic reports of six patients (seven solitary calcanear bone cyst) in the average age of 16.6 years. The mean follow-up was 3.8 years, minimum 2 years. Curettage and bone grafting yielded uniformly healing and regression of symptoms in 5 children. Multiple drilling (1 patient) and steroid acetate injection failed to show cyst healing. One bone cyst remained asymptomatic during follow-up. Our experience shows that, only large bone cysts and those causing pain should be treated surgically.     

Treatment of solitary cysts of the humerus

Summary The classical surgical treatment of unicameral bone cysts of the humerus with curettage and bone grafting is unreliable with approximately 40% failure rate. The author describes a technique of subperiosteal diaphyseal and metaphyseal resection and replacement with a section of fibula maintained in position with an intramedullary nail and further supported by massive tibial cortical and cancellous grafting. Consistent incorporation of the graft and excellent remodelling were observed in 36 patients so treated. No complications or recurrence were reported.

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Résumé Le traitement chirurgical «classique» des kystes solitaires de l'humérus par curettage et greffe osseuse ne donne pas des résultats constants, puisqu'il comporte environ 40% d'échecs. L'auteur décrit une technique de résection sous-périostée, diaphysaire et métaphysaire, avec remplacement par un fragment de péroné maintenu par enclouage centro-médullaire et complété par des greffons tibiaux cortico-spongieux. Une parfaite incorporation de la greffe et un excellent remodelage ont été obtenus dans les 36 cas traités de cette manière. Il n'y a eu ni complications, ni récidives.

     

Laparoscopic fenestration of biliary cysts.

We describe a new technique of biliary cyst fenestration using a videolaparoscopic approach. From June 1989 to October 1990, laparoscopic fenestration was performed for four symptomatic solitary cyst and one polycystic liver disease patients, without any morbidity. Mean hospital stay was short: 6.8 days (range of 3-14 days). No recurrence was observed on ultrasound controls with a mean follow-up of 6.4 months (range of 2-15 months). Laparoscopic fenestration for symptomatic biliary cysts is a simple, effective, and minimally invasive procedure.     

Complicated hydatid cysts of the liver]

In 328 cases of hydatid disease of the liver operated between 1979 and 1989, 51 (15.8%) had complicated cysts. The most frequent complication was intrabiliary rupture (2/3 of all complications). The others were intraperitoneal rupture in 7 cases (13.8%), suppuration in 7 cases (13.8%) and intrathoracic rupture in 3 cases (5.8%). Among the intrabiliary ruptured cysts, T-drainage was performed in 15 cases, choledochoduodenostomy was performed in 12 cases, and sphincteroplasty was performed in 7 cases. The cases of intraabdominal rupture were operated immediately. The suppurated cysts were marsupialized in 3 cases and drained in 4 cases. The 3 cases of bronchobiliary fistula were treated by T-tube drainage of the common bile duct, drainage of the pleural space, repair of the diaphragm and closure of the communicating bronchus. In this series, the mortality rate was 7.8% and the recurrence rate was 9.8%.     

Minimally invasive interventions in solitary liver cysts]

Large intrahepatic cysts need surgical intervention when becoming symptomatic. In case of non-parasitic solitary cysts different surgical treatments are available. We performed three different minimal-invasive procedures in 8 patients. Good results were obtained by laparoscopic extended deroofing of the cyst. Indications and technical performance are presented.