Patient Case Discussion
Case Summary
Pancreatitis in a Young Female
Discussed was a case of a 2 yo female patient who presented with vomiting, lethargy, and low appetite. The patient was previously healthy and did not have any abdominal pain. The patient was diagnosed with pancreatitis, based on elevated lipase levels and a high white blood cell count. The team discussed potential causes of pancreatitis in a young patient, ruling out gallstone disease due to the patient's age and lack of risk factors. They considered the possibility of anatomic abnormalities, such as a colloid cyst or annular pancreas, and the need to investigate further for potential hepatobiliary anomalies.
Common Bile Duct Dilatation in Child
Discussed was a case of a 2 yo patient with a common bile duct (CBD) dilatation, which was identified through ultrasound imaging. The dilatation was measured at 7.5 and was described as fusiform. The patient also had a partially contracted gallbladder with thickened walls and a distended cystic duct. The team considered the possibility of a choledochal cyst and the patient's risk for recurrent pancreatitis and malignant degeneration. The consensus was to operate and remove the cyst, but there was some debate about whether an MRCP should be performed for preoperative planning. The team decided not to intervene in the acute phase, allowing the patient to recover before considering elective surgery.
MRCp Debate for Pediatric Surgery
The Moderators discussed the necessity of an MRCp (magnetic resonance cholangiopancreatography) before a surgery for a 2 yo patient with a suspected polycystic liver disease. Preference for an MRCp for better pre-operative planning and to provide a clearer understanding of the anatomy to the family. However, some disagreed, stating that an intraoperative cholangiogram would provide better images and that an MRCp was not necessary. They agreed that the decision was a shared one with the parents, who were comfortable with the procedure.
Intraoperative Cholangiogram's Role in Surgery
The team discussed the importance of intraoperative cholangiogram in surgical procedures, particularly in cases of common bile duct obstruction. While MRC (magnetic resonance cholangiopancreatography) can provide useful information, it is not always sufficient for surgical planning. The team highlighted the value of an intraoperative cholangiogram in providing a clear image of the bile ducts and the pancreatic duct, which can be crucial for surgical decision-making. They also acknowledged the challenges of obtaining MRC in low-resource settings and the potential for false positives or negatives in MRC results. The team agreed on the importance of considering these factors when making surgical decisions.
Surgical Options for Choleidocal Cyst
Surgical options were discussed for a patient with a type one choleidocal cyst. It was suggested that resection of the cyst and the gallbladder, and re-anastomosis to the common bile duct, which was not recommended. Instead, hepaticojunostomy or hepaticoduodenostomy was proposed as the main options. The team also mentioned a laparoscopic assisted approach, which involved a small incision for the anastomosis due to the difficulty of the dissection.