背景:异位胆囊是一种罕见的异常,可导致对影像学发现的误解和临床混淆。这种异常的知识有助于准确的诊断和及时的管理。我们报告了一例异位胆囊合并先天性胆道扩张(CBD)的儿科病例。
方法:一名9岁女孩因肝脏酶水平升高而被转诊到我们医院。体格检查和医学影像学检查结果后,她被诊断为TodaniIV-A型CBD。我们无法通过腹部超声观察胆囊,CT,和核磁共振扫描;因此,我们怀疑胆囊发育不全.进行了腹腔镜肝外胆管切除术以治疗CBD。在肝脏下表面均未发现胆囊或胆囊管。因此,胆囊发育不全被认为是基于术前影像学和术中发现的诊断.然而,在肝门解剖期间,在肝总导管的腹侧发现了一个囊肿样结构,稍微向右,并发现了源自囊性结构的小附加导管。切口后,从小导管排出少量胆汁。因此,囊性结构被诊断为异位胆囊伴发育不全。切除异位胆囊后,切除肝外胆管。随后,腹腔镜肝空肠Roux-en-Y吻合术无任何并发症。切除标本的术后组织病理学评估显示,切除的囊性病变中有Rokitansky-Aschoff窦。病理检查证实了异位胆囊的诊断。经过平稳的术后过程,病人在第九天出院。
结论:据我们所知,这是第一例描述异位胆囊合并CBD的儿科病例报告.如果在术前影像学检查中无法检测到胆囊,重要的是要考虑异位胆囊的可能性。
BACKGROUND: An ectopic gallbladder is a rare anomaly and can result in the misinterpretation of imaging findings and clinical confusion. Knowledge of such anomalies facilitates accurate diagnoses and prompt management. We report a pediatric
case of an ectopic gallbladder concomitant with congenital biliary dilatation (CBD).
METHODS: A 9-year-old girl was referred to our hospital for elevated liver enzyme levels. Following physical examination and a review of medical imaging findings, she was diagnosed with Todani type IV-A CBD. We could not visualize the gallbladder by abdominal ultrasonography, CT, and MRI scans; therefore, we suspected gallbladder agenesis. A laparoscopic excision of the extrahepatic bile duct was performed to treat the CBD. Neither a gallbladder nor a cystic duct were revealed on the liver undersurface. Therefore, gallbladder agenesis was considered as a diagnosis based on preoperative imaging and intraoperative findings. However, during dissection of the hepatic hilum, a cyst-like structure was found on the ventral side of the common hepatic duct, slightly to the right, and a small additional duct that originated from the cystic structure was found. Upon incision, a small amount of bile was drained from the small duct. Thus, the cystic structure was diagnosed as an ectopic gallbladder with hypoplasia. Following the removal of the ectopic gallbladder, the extrahepatic bile duct was excised. Subsequently, laparoscopic Roux-en-Y hepaticojejunostomy was performed without any complications. Postoperative histopathological evaluations of the resected specimen revealed Rokitansky-Aschoff sinuses in the resected cystic lesion. The pathological investigations confirmed the diagnosis of an ectopic gallbladder. Following an uneventful postoperative course, the patient was discharged on day nine.
CONCLUSIONS: To our knowledge, this is the first pediatric
case report describing an ectopic gallbladder concomitant with CBD. If the gallbladder cannot be detected in a preoperative imaging examination, it is important to consider the possibility of an ectopic gallbladder.