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Case of the Month

March 2011

Patient Data: 1 year old female patient

Clinical Info: Acute abdominal pain and signs of peritonitis


37295-Afbeelding1.jpg
Abnormal common bile duct and peritoneal fluid


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Another image of the abnormal common bile duct and peritoneal fluid


37299-8971048_20100614_ABDOMEN-__0001.AVI.SWF videoclip of the abnormal common bile duct


37300-8971048_20100614_ABDOMEN-__0002.AVI.SWF Another videoclip of the abnormal common bile duct


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Normal flow in the portal vein, but no flow in the dilatated common bile duct


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Transverse image of the comon bile duct


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Another transverse image of the abnormal common bile duct. There is a normal gallbladder


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There is a lot of peritoneal fluid

Because we found only an abnormal wide common bile duct and no dilatated intrahepatic ducts and no dilatated gallbladder we concluded that there was probably a choledochal cyst. We could find no other explanation for the peritoneal fluid. A puncture of the fluid showed that it was bilious fluid. Because a ruptured choledochal cyst was suspected the patient was referred to a pediatric university hospital where the patient was operated. The final diagnosis was a ruptured choledochal cyst.

For more examples of choledochal cysts (in adults) and biliary pathology in children see

References
Spontaneous rupture of extrahepatic choledochal cyst: two pediatric cases and literature review.
Arda IS, Tuzun M, Aliefendioglu D, Hicsonmez A.
Eur J Pediatr Surg. 2005 Oct;15(5):361-3. Review.

Spontaneous perforation of choledochal cyst: a study of 13 cases.
Ando K, Miyano T, Kohno S, Takamizawa S, Lane G.
Eur J Pediatr Surg. 1998 Feb;8(1):23-5.

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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