Servizio di Radiologia "Direzione Universitaria"
G. Gavelli *Dip. di Discipline Chirurgiche Rianimatorie e dei Trapianti
A.Valsalva
Policlinico
S.Orsola-Malpighi Università di Bologna |
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13
YEARS OF EXPERIENCE IN OLT:
REVALUATION OF RESIDUAL CYSTIC DUCT MUCOCELE IN THE CHOLEDOCHO-CHOLEDOCAL
ANASTOMOSIS
M. Piolanti, M. Caputo, F. Gruppioni,
L. Albini, E. Fabbro, * G. Grazi, G. Gavelli
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 We
evaluated retrospectively the incidence of the mucocele
of the allograft cystic duct remnant in a series of 283
liver transplantations with a termino-terminal choledoco-choledocal
anastomosis.
This biliary complication is quite rare compared to others
such as biliary obstruction and bile leaks, and in our
series has never led to the necessity of new surgical
procedures.
The level of the junction between the cistic duct and
the choledoco is variable: in many cases it descends along
the common duct for a notable length before entering it.
In livers with this alteration removed for transplantation,
after performing homograft cholecystectomy, there is a
double lumen common duct with a long cystic duct and the
surgeon generally incorporates the cystic duct orifice
into the suture line of the choledoco-choledocal anastomosis
that may cause an obstruction.
This is the patogenetic moment of the mucocele: the epiteliar
secrection may cause its progressive dilatation with the
possibility of common duct compression. |
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The case material is drawn from
a series of 283 liver transplantations (263 patients)
performed between May 1986 and April 1999.
We retrospectively reviewed the ultrasonographic studies
the patients who underwent orthotopic liver transplantation
with a choledoco-choledocal anastomosis.
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thirteen patients (4.5 %) we found an anhecoic and round
lesion situated behind the portal vein and close to the
biliary anastomosis, suggestive of a non obstructive mucocele
of the residual cystic duct.
The size of the mucoceles in our series ranged from 12mm
to 36 mm..
None of the patients had ever shown clinical or laboratory
evidence of biliary obtruction or cholangitis due to the
presence of the cystic mucocele: this is in contradition
with the literature data.
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The
integrated imaging, the clinical and the surgical data
led, in thirteen patients, to the diagnosis of non obstructive
mucocele of the cystic duct remnant.
A hilar fluid collection is a very frequent U.S. finding
during the examination of a transplanted liver.
The differential diagnosis has to be put mainly with hepatic
artery aneurysm and pseudoaneurysm, loculated ascites,
lymphocele, bilomas, liquefied hematoma and remnant cystic
duct mucocele.
The ultrasonographic features of the mucocele are the
round shape, the well defined wall, the anechoic structure
and the typical localization (adjacent to the biliary
anastomosis).
In our series this complication is about 4.5 %, a higher
value than that reported in literature, suggesting to
investigate it carefully, as a not rare complication in
OLT. |
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- 9. Zajko AB, Bennett MJ, Campbell WL e Coll: Mucocele
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691-693, 1990 |
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