Case Discussion
Case Takeaways
A 6-month-old patient with elevated liver enzymes, vomiting, and white-gray stools, presenting with direct hyperbilirubinemia and pancreatitis markers. The surgical team considered differential diagnoses, including biliary anomalies, stones, and infection, with lab results showing elevated bilirubin, ALP, GGT, and lipase. The team agreed to investigate further with an ultrasound to assess for obstructive causes.
Choledochocyst Imaging and Management
The meeting focused on a detailed discussion of imaging findings for a patient with a choledochocyst, a rare congenital anomaly. Dr. Samartana presented ultrasound and MRCP images that revealed a tortuous, dilated common bile duct with a focal cystic dilation in the head of the pancreas, containing a non-calcified stone. The team discussed differential diagnoses, including PFIC and intrahepatic cholestasis, and considered the possibility of a mass lesion or sludge obstruction. Dr. Puligadla shared that the patient was doing well initially but presented a management challenge due to the rarity of the condition. The team deliberated on treatment options, including the potential for ERCP with sphincteroplasty or sphincterotomy for improved drainage, though the final decision was not specified in the transcript.
Transduodenal Sphincteroplasty for Choledochal Cyst
The team discussed a surgical procedure involving a transduodenal sphincteroplasty for a choledochal cyst in a young patient. Despite initial attempts to perform a cholangiogram through the cystic duct, they ultimately decided to proceed with the transduodenal approach because of difficulty passing instruments. The procedure was successful, with a 5 French catheter used to cannulate the ampulla and perform the sphincteroplasty. Post-operative course was unremarkable, and the patient will be followed up with both general surgery and GI teams. The pathology report showed a normal gallbladder with no obvious cause for stone formation.