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      Correctable biliary atresia and cholangiocarcinoma: a case report of a 63-year-old patient

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          Abstract

          Background

          Although cancer occurrence following surgery for biliary atresia has gradually increased, the development of cholangiocarcinoma in a native liver survivor of biliary atresia is extremely rare.

          Case presentation

          A 3-month-old female patient with the correctable type of biliary atresia underwent a cystoduodenostomy. At 16 years of age, she underwent multiple surgeries including lysis of intestinal adhesions, ileostomy, and gastrojejunostomy at another hospital. At 54 years of age, she underwent lithotomy at the porta hepatis, resection of the residual cystic bile duct with gallbladder, and hepaticojejunostomy in Roux-en-Y fashion. As she approached the age of 63, her computed tomography scan showed no liver tumors. In the following year, she developed cholangiocarcinoma at the porta hepatis and underwent chemotherapy. However, the cancer progressed, and she died before she reached the age of 64 years.

          Conclusions

          Cholangiocarcinoma is extremely rare in patients with biliary atresia. However, physicians should follow up patients with biliary atresia as closely as possible, as malignant tumors secondary to biliary atresia may increase in number in the near future because of the growing number of long-term survivors with biliary atresia.

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          Most cited references17

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          Japanese Biliary Atresia Registry

          Masaki Nio (2017)
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            Hepaticoduodenostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst.

            Roux-en-Y hepaticojejunostomy (HJ) is currently the favored reconstructive procedure after resection of choledochal cysts. Hepaticoduodenostomy (HD) has been argued to be more physiologically and technically easier but is feared to have associated complications. Here we compare outcomes of the 2 procedures.
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              Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?

              We reviewed our experience of Roux-en-Y hepaticojejunostomy (RYHJ) and hepaticoduodenostomy (HD) performed for the surgical repair of choledochal cyst (CC), with special emphasis on postoperative complications related to the type of biliary reconstruction performed. Eighty-six patients underwent primary cyst excision for CC from 1986 to 2002 at our institution. Forty-six cases with concurrent intrahepatic bile duct dilatation (IHBD) were excluded because HD was not used for biliary reconstruction if IHBD was present. Thus, 28 cases had RYHJ, and 12 had HD. Differences between the RYHJ and HD groups with respect to type of CC, age at cyst excision, and length of follow-up were not statistically significant. However, the incidences of postoperative complications related to biliary reconstruction, such as endoscopy-proven bilious gastritis due to duodenogastric bile reflux [4/12 (33.3%) of the HD group], and adhesive bowel obstruction/cholangitis [2/28 (7.1%) of the RYHJ group] were significantly different (p<.05). Our experience suggests that HD is not ideal for biliary reconstruction in CC because of a high incidence (33.3%) of complications due to duodenogastric bile reflux. Currently, RYHJ is our exclusive technique of choice for biliary reconstruction during the surgical repair of CC.
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                Author and article information

                Contributors
                mnio@ped-surg.med.tohoku.ac.jp
                wada@ped-surg.med.tohoku.ac.jp
                h-sasaki@ped-surg.med.tohoku.ac.jp
                tanaka@ped-surg.med.tohoku.ac.jp
                hashimoto@ped-surg.med.tohoku.ac.jp
                nakajima@ped-surg.med.tohoku.ac.jp
                Journal
                Surg Case Rep
                Surg Case Rep
                Surgical Case Reports
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2198-7793
                29 November 2019
                29 November 2019
                December 2019
                : 5
                : 185
                Affiliations
                ISNI 0000 0001 2248 6943, GRID grid.69566.3a, Department of Pediatric Surgery, , Tohoku University Graduate School of Medicine, ; 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Japan
                Author information
                http://orcid.org/0000-0002-5862-1067
                Article
                748
                10.1186/s40792-019-0748-9
                6884610
                31784849
                727fc0a9-79d4-4aa3-a656-1d536c0e617b
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 23 August 2019
                : 11 November 2019
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2019

                biliary atresia,correctable type,long-term survivor,cholangiocarcinoma

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