A case of intraduodenal diverticulum imitating choledochocele

Kovachev, L; Deliisky, T; Marinov, EvlogiE.

doi:10.1007/bf01627895

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…In this study, there was also a cyst in distal common bile duct region that showed well-formed intestinal wall including villous architecture, absorptive epithelium with scattered goblet cells, as well as Paneth cells and a well-formed muscularis mucosa. In the literature, some of the cases of Todani type III CCs (also called choledochocele or intraduodenal diverticulum) have been shown to have duodenal mucosa as in this case 26–29 …”

Section: Discussionmentioning

confidence: 93%

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Evaluation and Pathologic Classification of Choledochal Cysts

Mericoz¹,

Hacıhasanoğlu²,

Muraki³

et al. 2021

American Journal of Surgical Pathology

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Choledochal cyst (CC) is believed to be a mostly Asian disorder. As a clinically defined entity, its pathologic correlates are poorly characterized. Eighty-four resected CCs from the West were reanalyzed. After applying established Japanese criteria, 9/66 with available imaging were disqualified and 10/39 with preoperative cyst typing had to be recategorized. None had been diagnosed with, or evaluated for, pancreatobiliary maljunction, but on retrospective analysis of radiologic images, 12/66 were found to have pancreatobiliary maljunction. The clinical findings were: F/M=5.7; mean age, 48; most (77%) presented with abdominal pain; mean size, 2.9 cm; choledocholithiasis 11%. Gross/histologic examination revealed 3 distinct pathology-based categories: (I) Cystic dilatation of native ducts (81%). (II) Double bile duct (13%), almost all of which were found in women (10/11); all were diagnosed by pathologic examination, and not preoperative diagnosis. (III) Gastrointestinal (GI) duplication type (6%). Microscopic findings of the entire cohort included mucosal-predominant lymphoplasmacytic inflammation (50%), follicular cholangitis (7%), mucosal hyperplasia (43%; 13% with papillae), intestinal metaplasia (10%), BilIN-like hyperplasia (17%), erosion/ulceration (13%), and severe dysplasia-mimicking atypia including “detachment atypia” and micropapillary degeneration (11%). Carcinomatous changes were seen in 14 cases (17%) (high-grade dysplasia/carcinoma in situ in 7, intraductal papillary neoplasm 1, and invasive carcinoma 6); and 13/14 of these occurred in pathologic category I, all with cyst size >1 cm. In conclusion, diagnostic imaging guidelines used in Asia are not routinely used (but should be adopted) in the West. Pathologically, cases designated as CC are classifiable in 3 groups: category 1 (dilated native duct type), more prone to carcinomatous change; category 2, double-duct phenomenon (all but 1 being female in this study); and category 3, GI-type duplication. Overall, 17% of CCs show carcinomatous change (50% of them invasive). CC specimens should be carefully examined with this classification and submitted entirely for assessment of at-risk mucosa and cancerous transformation.

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Section: Discussionmentioning

confidence: 93%

“…In the literature, some of the cases of Todani type III CCs (also called choledochocele or intraduodenal diverticulum) have been shown to have duodenal mucosa as in this case. [26][27][28][29]…”

Section: Pathologically Ccs Can Be Classified Into 3 Categories Which...mentioning

confidence: 99%

Evaluation and Pathologic Classification of Choledochal Cysts

Mericoz¹,

Hacıhasanoğlu²,

Muraki³

et al. 2021

American Journal of Surgical Pathology

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Intraluminal Duodenal Diverticula: Collective Review with Report of a Laparoscopic Excision

Meinke

Meighan

Meinke

et al. 2013

Journal of Laparoendoscopic & Advanced Surgical Techniques

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A comprehensive review of intraluminal duodenal diverticulum (IDD) is presented, along with a report of a completely laparoscopic excision of this duodenal abnormality as well as a report of magnetic resonance cholangiopancreatography demonstrating the classic fluoroscopic "wind sock sign" pathognomonic appearance of IDD. IDD may easily be missed unless one specifically considers this entity in patients presenting with symptoms of foregut disease. Patients with IDD typically present in the fourth decade of life with duration of symptoms less than 5 years that typically include pain, nausea and vomiting, pancreatitis, and gastrointestinal bleeding. Diagnosis usually requires imaging studies and upper gastrointestinal endoscopy. Laparoscopic excision is recommended because of superior visualization of significant intestinal anatomic abnormalities, the need for accurate ampullary localization, and the ability to facilitate complete diverticular excision while maintaining biliary and pancreatic ductal integrity. Review of surgical literature suggests that IDD results from congenital duodenal developmental abnormalities matured by long-term duodenal peristalsis.

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A case of intraduodenal diverticulum imitating choledochocele

Cited by 2 publications

References 8 publications

Evaluation and Pathologic Classification of Choledochal Cysts

Evaluation and Pathologic Classification of Choledochal Cysts

Intraluminal Duodenal Diverticula: Collective Review with Report of a Laparoscopic Excision

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