Лучевая диагностика холедохоцеле в детском возрасте (описание случая и обзор литературы)

Холедохоцеле – это кистозное расширение дистального сегмента общего желчного протока, выступающее в просвет двенадцатиперстной кишки. Это крайне редкое врожденное поражение. В статье описано наблюдение 5-летнего ребенка с неосложненным холедохоцеле. В ходе предоперационной диагностики по данным как ультразвукового исследования, так и магнито-резонансной холангиопанкреатографии не удалось провести достоверную дифференциальную диагностику между кистой желчного протока III типа и кистозным удвоением двенадцатиперстной кишки. Ребенку выполнена плановая дуоденотомия с иссечением кисты, послеоперационный период протекал благополучно. В статье описаны ультразвуковые признаки, характерные для данного варианта порока развития желчных ходов, приведены обзор литературы с описанием эмбриогенеза заболевания, а также сведения о сравнительной точности ультразвуковых, лучевых и эндоскопических методов диагностики.

1. Todani T., Watanabe Y., Narusue M. et al. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am. J. Surg. 1977; 134 (2): 263–269. https://doi.org/10.1016/0002-9610(77)90359-2

2. Edil B.H., Cameron J.L., Reddy S. et al. Choledochal cyst disease in children and adults:

3. a 30-year single-institution experience. J. Am. Coll. Surg. 2008; 206: discussion 1000–1005. https://doi.org/10.1016/j.jamcollsurg.2007.12.045

4. Wheeler W. An unusual case of obstruction to the common bile duct (choledochocele?). Br. J. Surg. 1940; 27:4 46–448. https://doi.org/10.1002/bjs.18002710705

5. Разумовский А.Ю., Митупов З.Б., Куликова Н.В., Степаненко Н.С., Задвернюк А.С., Адлер А.В., Шубин Н.В. Реконструкция жёлчных ходов при мальформации холедоха у детей. Детская хирургия. 2021; 25 (1): 4–10. https://dx.doi.org/10.18821/1560-9510-2021-25-1-4-10

6. Соколов Ю.Ю., Чиркина Т.А., Лапушкин В.А., Беседин Г.С. Комплексная лучевая диагностика холедохоцеле у ребенка. Ультразвуковая и функциональная диагностика. 2001; 3: 98–100.

7. Vakili K., Pomfret E.A. Biliary Anatomy and Embryology. Surg. Clin. North Am. 2008; 88 (6): 1159–1174. https://doi.org/10.1016/j.suc.2008.07.001

8. Ziegler K.M., Pitt H.A., Zyromski N.J. et al. Choledochoceles: are they choledochal cysts? Ann. Surg. 2010; 252 (4): 683–690. https://doi.org/10.1097/SLA.0b013e3181f6931f

9. Kim T.H., Park J.S., Lee S.S. et al. Carcinoma arising in choledochocele: is choledochocele innocent bystander or culprit? Endoscopy. 2002; 34 (8): 675–676; author reply 677. https://doi.org/10.1055/s-2002-33242

10. Le Roy B., Gagnière J., Filaire L. et al. Pancreaticobiliary maljunction and choledochal cysts: from embryogenesis to therapeutics aspects. Surg. Radiol. Anat. 2016; 38 (9): 1053–1060. https://doi.org/10.1007/s00276-016-1669-y

11. Sarris G.E., Tsang D. Choledochocele: case report, literature review, and a proposed classification. Surgery. 1989; 105 (3): 408–414. PMID: 2646745

12. Eiamkulbutr S., Tubjareon C., Sanpavat A. et al. Diseases of bile duct in children Wld J. Gastroenterol. 2024; 30 (9): 1043–1072. https://doi.org/10.3748/wjg.v30.i9.1043

13. Saad M., Abu-El-Haija M., Lin T.K. et al. Endoscopic cystostomy and biliary sphincterotomy for choledochoceles: A pediatric case series. J. Pediatr. Gastroenterol. Nutr. Reports. 2024; 5 (4): 475–479. https://doi.org/10.1002/jpr3.12118

14. Novak I., Bitton S. The Role of Endoscopic Ultrasound in the Diagnosis and Management of Congenital Gastrointestinal and Pancreaticobiliary Conditions. Curr. Gastroenterol. Rep. 2026; 28 (1): 16. https://doi.org/10.1007/s11894-026-01040-7

15. Ghazi A., Slone E. Endoscopic management of choledochocele. A case report and review of the English literature. Surg. Endosc. 1987; 1 (3): 151–154. https://doi.org/10.1007/BF00590921

16. Scholz F.J., Carrera G.F., Larsen C.R. The choledochocele: correlation of radiological, clinical and pathological findings. Radiology. 1976; 118 (1): 25–28. https://doi.org/10.1148/118.1.25

17. Makin E., Davenport M. Understanding choledochal malformation. Arch. Dis. Child. 2012; 97 (1): 69–72. https://doi.org/10.1136/adc.2010.195974

18. Naik-Mathuria B., Olutoye O.O. Foregut abnormalities. Surg. Clin. North Am. 2006; 86 (2): 261–284. https://doi.org/10.1016/j.suc.2005.12.011

19. Kronfli R., Davenport M. Insights into the pathophysiology and classification of type 4 choledochal malformation. J. Pediatr. Surg. 2020; 55 (12): 2642–2646. https://doi.org/10.1016/j.jpedsurg.2020.05.017

20. De Backer A., Van den Abbeele K., De Schepper A. et al. Choledochocele: diagnosis by magnetic resonance imaging. Abdom. Imaging. 2000; 25 (5): 508–510. https://doi.org/10.1007/s002610000082

21. Achatsachat P., Intragumheang C., Srisan N. et al. Surgical aspects of choledochal cyst in children and adults: an experience of 106 cases. Pediatr. Surg. Int. 2024; 40 (1): 183–187. https://doi.org/10.1007/s00383-024-05777-y

22. Ray S., Saha H., Sen S. et al. Presentation and outcomes of surgery for choledochal cyst in children and adults: an experience of 329 cases. Updates Surg. 2025; 77: 459–470. https://doi.org/10.1007/s13304-025-02138-9

23. Goldberg P.B., Long W.B., Oleaga J.A., Mackie J.A. Choledochocele as a cause of recurrent pancreatitis. Gastroenterology. 1980; 78 (5, Pt 1): 1041–1045. https://doi.org/10.1016/0016-5085(80)90789-1

24. Salemis N.S., Liatsos C., Kolios M., Gourgiotis S. Recurrent acute pancreatitis secondary to a duodenal duplication cyst in an adult. A case report and literature review. Canadian J. Gastroenterol. 2009; 23 (11): 749–752. https://doi.org/10.1155/2009/979431

25. Lakhtakia S., Gupta R., Mateen M.A. et al. Giant choledochocele presenting as intussusception (with video). Gastrointest. Endosc. 2008; 68 (6): 1194–1195; discussion 1196. https://doi.org/10.1016/j.gie.2008.05.058

26. McArdle A., Conneely J.B., Ravi N., Reynolds J.V. Duodenal duplication cyst presenting with gastric outlet obstruction in an adult male. Endoscopy. 2011; 43, Suppl. 2 UCTN: E352–353. https://doi.org/10.1055/s-0030-1256857

27. Chang H.C., Huang S.C., Wu R.C., Yu M.C. Duodenal duplication cyst: a rare cause of geriatric gastrointestinal bleeding. J. Chin. Med. Assoc. 2011; 74 (5): 233–236. https://doi.org/10.1016/j.jcma.2011.03.010

28. Birch M., Adler D.G. Simultaneous choledochocele and PSC in a single patient: a unique combination. Am. J. Gastroenterol. 2012; 107 (12): 1924–1925. https://doi.org/10.1038/ajg.2012.304

29. Ohtsuka T., Inoue K., Ohuchida J. et al. Carcinoma arising in choledochocele. Endoscopy. 2001; 33 (7): 614–619. https://doi.org/10.1055/s-2001-15324

30. Horaguchi J., Fujita N., Kobayashi G. et al. Clinical study of choledochocele: is it a risk factor for biliary malignancies? J. Gastroenterol. 2005; 40 (4): 396–401. https://doi.org/10.1007/s00535-005-1554-7

31. Shah O.J., Shera A.H., Zargar S.A. et al. Choledochal cysts in children and adults with contrasting profiles: 11-year experience at a tertiary care center in Kashmir. Wld J. Surg. 2009; 33 (11): 2403–2411. https://doi.org/10.1007/s00268-009-0184-2

32. Alonso-Lej F., Rever W.B. Jr., Pessagno D.J. Congenital choledochal cyst, with a report of 2, and an analysis of 94, cases. Int. Abstr. Surg. 1959; 108 (1): 1–30. PMID: 13625059

33. Cakmakci E., Ugurlar O.Y., Erturk S.M. et al. Sonographic diagnosis of choledochocele. J. Clin. Ultrasound. 2012; 40 (7): 448–450. https://doi.org/10.1002/jcu.20877

34. Gordon S.R., Levenick J.M., Rath D.L., Gardner T.B. Case of a closed choledochocele with biliary and pancreatic drainage via the accessory duct causing acute pancreatitis. Dig. Endosc. 2009; 21 (2): 106–108. https://doi.org/10.1111/j.1443-1661.2009.00832.x

35. Li T., Jiang Y.J., Xie R. Endoscopic Ultrasound Diagnosis and ERCP Treatment of Type III Choledochal Cyst: A Case Report and Review of Literatures. J. Dig. Dis. 2026; 27 (1–2): 99–102. https://doi.org/10.1111/1751-2980.70042

36. Zhu Y., Xu W., Lv Y. et al. Complex pancreaticobiliary maljunction diagnosed by endoscopic ultrasound: A case report. Medicine (Baltimore). 2024; 103 (50): e40841. https://doi.org/10.1097/MD.0000000000040841

37. Masetti R., Antinori A., Coppola R. et al. Choledochocele: changing trends in diagnosis and management. Surg. Today. 1996; 26 (4): 281–285. https://doi.org/10.1007/BF00311589

38. Cannella R., Giambelluca D., Diamarco M. Congenital Cystic Lesions of the Bile Ducts: Imaging-Based Diagnosis. Curr. Probl. Diagn. Radiol. 2020; 49 (4): 285–289. https://doi.org/10.1067/j.cpradiol.2019.04.005

39. Saeedi K.A., Chavhan G.B., Gonska T. et al. Frequency on Magnetic Resonance Cholangiopancreatography and Associated Pancreaticobiliary Diseases. Invest. Radiol. 2026; 61 (2): 121–126. |https://doi.org/10.1097/RLI.0000000000001217

40. Okamoto T., Fukuda K. Endosonographic diagnosis of choledochocele. Endosc. Int. Open. 2021; 09: E1579–E1580. https://doi.org/10.1055/a-1526-1706

41. Lobeck I.N., Dupree P., Falcone R.A. Jr. et al. The presentation and management of choledochocele (type III choledochal cyst): A 40-year systematic review of the literature. J. Pediatr. Surg. 2016; 52 (4): 644–649. http://dx.doi.org/10.1016/j.jpedsurg.2016.10.008

42. Hackert T., Hartwig W., Werner J. Symptoms and surgical management of a distal choledochal cyst in a patient with pancreas divisum: case report and review of the literature. Case Rep. Gastroenterol. 2007; 1 (1): 90–95. https://doi.org/10.1159/000108636

43. Adams S.N., Riffert D. J. Martinez A. et al. Robotic-assisted transduodenal marsupialization of a choledochocele causing recurrent pancreatitis in an adolescent with pancreas divisum: a case report. J. Pediatr. Surg. Case Rep. 2026; 128: 103220. https://doi.org/10.1016/j.epsc.2026.103220

44. Разумовский А.Ю., Митупов З.Б., Куликова Н.В., Степаненко Н.С., Задвернюк А.С., Титова Е.А., Шубин Н.В. Мини-лапаротомия при лечении мальформации холедоха у детей. Детская хирургия. 2021; 25 (3): 165–173. https://dx.doi.org/10.18821/1560-9510-2021-25-3-165-173

45. Разумовский А.Ю., Дегтярева А.В., Ускова Н.Г., Куликова Н.В., Феоктистова Е.В., Рачков В.Е. Эндохирургия в лечении пороков желчевыводящих путей у детей. Экспериментальная и клиническая гастроэнтерология. 2014; 101: 59–65.

46. Miyano G., Cazares J., Koga H. Choledochal cyst. Holcomb and Ashcraft's Pediatric Surgery, 2026; Elsevier: 639-650.e1.