Dilatazione congenita della via biliare principale nell’adulto

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COD: 06_2011_493-498 Categorie: ,

Silvio Ungania, Nives Barletta

Ann. Ital. Chir., 2011; 82: 493-498

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The authors refer to three cases of congenital dilatation of the biliary system in an adult, an extremely rare pathology
in the West, with no specific symptomatology, and therefore often discovered accidentally and unexpectedly.
The first patient had suffered from unexplained periods of fever since childhood, the second had only complained of
vague abdominal pains a years before diagnosis; for the third, a Romanian woman, it was the first time she complained
of a biliary colic. All the patients had an Ultrasound, a CT scan and a MRCP (magnetic resonance cholangiopancretography).
Based on the Todani classification, the first and the third case belongs to type IV A, while the second is a
type I. In all three patients the pathology was resolved due to an operation entailing disconnection of the biliary-pancreatic
tract, with complete surgical removal of the dilated bile ducts followed by a Roux-en-Y hepatico-jejunostomy.
Nevertheless the procedures undertaken are not immune to criticism: in the first and second case the diagnostic imagery
had not immediately produced a clear interpretation, leading to a delay in the diagnosis and the execution in the first
of a not anodyne ERCP; in the third case a colecistectomy was performed as it were as an intermediary measure; finally
there was probably omitted a thorough explanation to the patient with regard to a pathology deserving of a careful
follow-up for the possible recidivist of the infectious phenomena and above all the onset of the dangerous degeneration
carcinomatosa.

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