7. PALPATION
Abdomen soft, non-distended
Tenderness in the Right Hypochondrium
No rise of temperature, guarding / rigidity
No organomegaly, palpable lumps
PERCUSSION
Abdomen tympanic all over
No free fluid
Liver dullness in the 5th ICS with a span of 6cm

8. SYSTEMIC EXAMINATION –
NORMAL

9. • CBC – Normal
• LFT – Sr Bilirubin – 1.5 mg/dl (D – 0.6; I – 0.9 mg/dl) , SGOT & SGPT – Normal
• Coagulation profile – Normal ; Sr.Alkaline Phosphatase – Normal
• Ultrasound (outside) - ? Double gb with calculi

16. 1
2
3
4
5
6

17. CYSTIC DUCT
Bile Duct Cyst
Lower end Clipped
Umbilical tape

18. Bile Duct Cyst
Hepatic Artery
PortalVein
Duodenum

19. Upper end
Lower end
Gallbladder

20. Well-differentiated Papillary
adenocarcinoma in the fundus reaching at one focus upto the muscle [pTIb]. Section
from body and neck show chronic non-specific cholecystitis. Sections of the cyst are
lined by cuboidal epithelium, wall shows inflammation, congestion, & fibrosis
consistent with Choledochal Cyst. No evidence of malignancy seen
• Review report –Lymph Nodes negative for mets
Drain output –
POD 1 - 150 ml bilious
POD 2 - 100 ml bilious
POD 3 - 100 ml bilious
POD 4 - 50 ml bilious

23. • Anomalous arrangement of the PANCREATOBILIARY duct junction
(A J P B D S)
KIMURATYPE I - Pancreatic duct
enters the CBD
(10-58%)
KIMURATYPE II - CBD drains into the
Pancreatic duct

24. KOMI TYPE I -CBD joins PD at a
right angle
KOMI TYPE II -CBD joins PD at an
acute angle
KOMI TYPE III - CBD & PD form a
complicated network
subdivided according
to “WARSHOW
classification”
KOMI et al

25. • Associated along with an AJPBDS
• Pathological anatomy leading to reflux of enzymes
• Support –
• Biliary Manometric Studies (Iwai et al, 1986)
• High Pancreatic enzyme levels (Todani et al, 1990)
• Histopathology of Cyst wall (Oguchi et al, 1988)
• Oligoganglionosis of the distal CBD

30. • Neoplastic
• Cholangiocarcinoma
• Carcinoma GB
• Hepatocellular Carcinoma
• Pancreatic carcinoma
• Miscellaneous
• Hepatic Cirrhosis
• Portal Hypertension

38. • SIMPLE
• PERIPORTAL FIBROSIS

39. MULTIPLANAR
VOLUME RENDER

42. 35 Dr Palanivelu and colleagues
• Advantages to the patient
• Advantages to the operating surgeon