Multiple cholangiogenic liver abscesses with cystic transformation of bile ducts
In the present paper we show a rare case of choledocal cyst type IVa according to T. Todani classification in a 46-year-old patient. Four years after cystoenterostomy without cyst excision, a severe cholangitis developed. Multiple small abscesses of the right lobe of the liver were identified. Puncture-drainage and antibacterial treatment was started, diagnostic laparotomy was performed, but the patient's condition progressively worsened. So the patient was admitted to the Vishnevsky National Medical Surgery Research Center, where the diagnosis was confirmed. According to vital indications, a right hepatectomy was performed, a large cyst was removed, and Roux-en-Y hepaticojejunostomy was formed with the left lobar duct. In early postoperative period the patient developed biliary leakage. Late complications include anastomotic stricture with obstructive jaundice and episode of cholangitis, which was resolved by percutaneous transhepatic cholangiography and external-internal biliary drainage. The analysis of literature data, etiology, classification, pathogenesis of cystic transformations of extra- and intrahepatic bile ducts is presented. An assessment of the methods of surgical treatment of the disease and its complications is given. Surgical treatments of choledochal cysts and its complications were evaluated.