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Differential Diagnosis for Post-Operative T Tube Cholangiogram Findings

Single Most Likely Diagnosis

  • Choledochal Cyst: The presence of a dilated common bile duct (CBD) with contrast seen in the second part of the duodenum, pancreatic duct, and a common channel is highly suggestive of a choledochal cyst, specifically a type I or type III choledochal cyst, which involves the CBD and can have a common channel with the pancreatic duct.

Other Likely Diagnoses

  • Anomalous Pancreaticobiliary Junction (APBJ): This condition involves an abnormal junction between the pancreatic and bile ducts, which can lead to a common channel and reflux of bile into the pancreatic duct, consistent with the findings on the T tube cholangiogram.
  • Bile Duct Stricture or Stenosis: A stricture or stenosis in the CBD could cause dilation of the bile duct and potentially lead to the formation of a common channel with the pancreatic duct, especially if there is a fistula or if the stricture is causing significant obstruction.

Do Not Miss Diagnoses

  • Pancreatic Cancer or Cholangiocarcinoma: Although less likely given the specific findings of a common channel and dilation, it is crucial not to miss a malignancy such as pancreatic cancer or cholangiocarcinoma, which could cause obstruction and dilation of the CBD and potentially involve the pancreatic duct.
  • Bile Duct Injury: Post-operative bile duct injury could lead to a fistula between the bile duct and the pancreatic duct or duodenum, resulting in the observed findings on the cholangiogram.

Rare Diagnoses

  • Congenital Bile Duct Cyst with Anomalous Pancreaticobiliary Junction: This is a rare condition where a choledochal cyst is associated with an anomalous pancreaticobiliary junction, which could explain the findings on the T tube cholangiogram.
  • Pancreaticobiliary Maljunction (PBM) without Choledochal Cyst: A rare condition where there is an anomalous junction between the pancreatic and bile ducts without the presence of a choledochal cyst, which could still lead to a common channel and the observed radiographic findings.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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