3,342 results match your criteria Choledochal Cyst
World J Clin Cases 2018 Nov;6(14):842-846
Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China.
Choledochocele (also known as type III choledochal cyst according to Todani's classification) is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Cases are rare and the etiology remains unclear. It is usually misdiagnosed as peptic ulcer, as in the patient whose case is described here. Read More
Int J Surg Case Rep 2018 Nov 12;53:322-326. Epub 2018 Nov 12.
Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia. Electronic address:
Introduction: Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the leading method to manage the patients. Read More
Pediatr Surg Int 2018 Nov 7. Epub 2018 Nov 7.
Department of Pediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Choledochal malformations (CMs) represent a spectrum of relatively rare and complex congenital anomalies, characterized by abnormal dilatation of the biliary tract in the absence of any acute obstruction. Today, almost 20% of CMs can be detected in-utero using maternal ultrasonography. Formal scientometric analysis was used to identify where modern CM research is taking place and perhaps where our attention should be directed in the future. Read More
Clin Nucl Med 2019 Jan;44(1):e51-e53
Department of Nuclear Medicine, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, People's Republic of China.
Choledochal cysts are rare congenital anomalies of the biliary tree, which are more prevalent in female Asian population. Malignant transformation occurs in 10% to 30% of adults with choledochal cysts. A 39-year-old man presented with abdominal pain for 2 months, with irregular thickening of bile duct wall on ultrasound and enhanced CT. Read More
European J Pediatr Surg Rep 2018 Jan 18;6(1):e83-e86. Epub 2018 Oct 18.
Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India.
Choledochal cyst (CC) is an important surgical cause of jaundice in infants. Infantile variant of CC can mimic biliary atresia in clinical presentation. CC associated with biliary atresia is well described in literature. Read More
J Hepatobiliary Pancreat Sci 2018 Oct 16. Epub 2018 Oct 16.
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
Background: The aim of the present study was to investigate the characteristics, management, and outcomes of congenital biliary dilatation (CBD) in neonates and infants (<1 year old) in a single institution over the past 20 years.
Methods: From 1997 to 2016, 21 patients <1 year old underwent definitive surgery for CBD. Open surgery (OS) was performed between 1997 and 2008, and laparoscopic surgery (LS) has been performed since 2009. Read More
Chin Med Sci J 2018 Sep;33(3):194-203
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Choledochocele is a congenital abnormality of the biliary system, which characterized by a cystic dilatation of intramural segment of the distal common bile duct. Choledochocele manifests as cystic lesions in the duodenal lumen and resembles duodenal duplication cysts in imaging. We reported a patient with choledochocele. Read More
J Hepatobiliary Pancreat Sci 2018 Oct 16;25(10):440-447. Epub 2018 Oct 16.
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
Background: Portal cavernoma cholangiopathy (PCC), a surgical-endoscopic dilemma, has not been studied comprehensively, more so in children. Our study aimed to evaluate PCC in children using a combination of magnetic resonance cholangiography-portovenography (MRC-MRPV) and endoscopic ultrasonography (EUS).
Methods: In this prospective cross-sectional study, recruited children with extrahepatic portal venous obstruction (EHPVO) underwent MRC-MRPV and radial array EUS. Read More
Indian J Pediatr 2018 Sep 12. Epub 2018 Sep 12.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Biliary tract shows a large number of anatomic variations and duplication of the bile duct is an extremely rare anomaly. It has been reported to be associated with other congenital conditions like Abnormal Pancreato Biliary Junction (APBJ), biliary atresia and choledochal cyst and may lead to complications like cholangitis, choledocholithiasis and malignancy. The clinical presentation may be with one of the above complications and the condition usually reveals itself only on imaging investigations, as a surprise to the radiologist and the surgeon. Read More
J Minim Access Surg 2018 Sep 3. Epub 2018 Sep 3.
Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital Cum Research Institute, Jaipur, Rajasthan, India.
A Type II choledochal cyst arising from the right hepatic duct may mimic a gall bladder duplication. Both are rare and may not get differentiated before operative exploration. While a magnetic resonance cholangiopancreatography (MRCP) may be helpful, laparoscopy may be the final tool for evaluation and effective surgical treatment. Read More
BMC Gastroenterol 2018 Aug 23;18(1):129. Epub 2018 Aug 23.
Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, 100853, China.
Background: The purpose of this study was to compare the impact of the extent of excision and the patent bile duct flow on treatment outcomes of bile duct cysts (BDCs).
Methods: We retrospectively analyzed the records of 382 patients who received surgery for BDCs from January 2005 to December 2014.
Results: For Type Ia cysts, proper bile flow was associated with good long-term treatment outcomes with a greater level of significance (p < 0. Read More
Saudi J Anaesth 2018 Jul-Sep;12(3):499-500
Department of Anaesthesiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
World J Gastroenterol 2018 Aug;24(29):3260-3272
Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China.
Aim: To analyze the expression and function of the Notch signaling target gene Hes1 in a rhesus rotavirus-induced mouse biliary atresia model.
Methods: The morphologies of biliary epithelial cells in biliary atresia patients and in a mouse model were examined by immunohistochemical staining. Then, the differential expression of Notch signaling pathway-related molecules was investigated. Read More
World J Clin Cases 2018 Jul;6(7):143-149
Department of Pediatrics, PLA General Hospital, Beijing 100853, China.
Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3 robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. Read More
Clin Res Hepatol Gastroenterol 2018 Aug 2. Epub 2018 Aug 2.
Department of Medicine, Marienhausklinik St. Josef Kohlhof, Klinikweg 1-5, 66539 Neunkirchen, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany. Electronic address:
Clin Gastroenterol Hepatol 2018 Aug 2. Epub 2018 Aug 2.
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiang Su Province, China.
Pediatr Surg Int 2018 Oct 2;34(10):1087-1092. Epub 2018 Aug 2.
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Purpose: We previously showed that meticulous probing and resection of the intrahepatic bile duct stenosis (IHBDS)-causing membrane or septum was effective in preventing hepatolithiasis after choledochal cyst excisions in open surgeries. Then, we introduced this maneuver into laparoscopic choledochal cyst excisions in 2014 and performed routine resections since then. The aim of this study was to show the feasibility of this method in laparoscopic surgery. Read More
J Med Ultrasound 2017 Oct-Dec;25(4):235-239. Epub 2017 Dec 8.
Department of Radiology, Taipei Veterans General Hospital, School of Medicine, National Yang Ming University, Taipei, Taiwa.
Choledochal cysts rarely present with acute pancreatitis. We report a patient with type I choledochal cyst(s) who had concomitant acute frank hemorrhagic pancreatitis. A 14-year-old male noted with a history of recurrent abdominal pain, fever and jaundice. Read More
Pan Afr Med J 2018 16;29:156. Epub 2018 Mar 16.
Service de Chirurgie Hépatobiliaire et Greffe du Foie, Etablissement Hospitalo-Universitaire d'Oran, Algérie.
J Indian Assoc Pediatr Surg 2018 Jul-Sep;23(3):161-163
Department of Pediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
A 1-year-old male child presented with progressive jaundice. Investigations were suggestive of an obstructive pathology with a suspected choledochal cyst on imaging. Intraoperative cholangiogram demonstrated runoff of contrast from the cystic duct into the common bile duct with no opacification of the biliary system proximal to this. Read More
Int J Surg Pathol 2018 Jul 1:1066896918786586. Epub 2018 Jul 1.
1 University of Texas Southwestern Medical Center, Dallas, TX, USA.
Primary visceral myopathy caused by a pathogenic mutation in the gene encoding the enteric smooth muscle actin gamma 2 ( ACTG2) affects gastrointestinal and genitourinary tracts and often presents as chronic intestinal pseudoobstruction. We present a case of pediatric onset chronic intestinal pseudoobstruction associated with a novel missense ACTG2 mutation c.439G>T/p. Read More
Crit Ultrasound J 2018 Jul 12;10(1):14. Epub 2018 Jul 12.
Department of Emergency Medicine, New York-Presbyterian, Brooklyn Methodist Hospital, Brooklyn, NY, USA.
Background: The use of point-of-care ultrasound (POCUS) has become increasingly important in resource-limited settings. It can rapidly diagnose both tropical infectious diseases and more common pathology at the bedside. In these practice settings, POCUS can have a significant impact on management strategies and patient care. Read More
Rev Col Bras Cir 2018 Jul 10;45(3):e1854. Epub 2018 Jul 10.
- Pequeno Príncipe Hospital, Department of Pediatric Surgery, Curitiba, PR, Brazil.
Objective: to describe the first 13 cases of laparoscopic correction of common bile duct cyst in the Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil.
Methods: we performed a retrospective analysis of medical records of cases of choledochal cyst operated by laparoscopy between March 2014 and September 2016.
Results: of the 13 patients, eight were female and the mean age at surgery was 7. Read More
Pediatr Gastroenterol Hepatol Nutr 2018 Jul 28;21(3):203-208. Epub 2018 Jun 28.
Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea.
Purpose: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation.
Methods: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Read More
Am Surg 2018 Jun;84(6):868-874
A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass. We review our experience with such patients to provide insight into improving evaluation before cholecystectomy. Retrospective chart review of patients undergoing cholecystectomy from 2004 to 2015 identified six patients who underwent laparoscopic cholecystectomy for biliary colic before being diagnosed with a pancreatic head neoplasm within six months after cholecystectomy. Read More
Eur J Pediatr Surg 2018 Jun 17. Epub 2018 Jun 17.
Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, China.
Objectives: Biliary atresia (BA) is a progressive inflammatory obstructive cholangiopathy in infants. High mobility group box 1 (HMGB1) is known to play an important role as a late mediator of inflammation. However, it is not clear whether HMGB1 levels are of clinical significance in patients with BA. Read More
Radiol Case Rep 2018 Apr 9;13(2):415-418. Epub 2018 Feb 9.
Department of Pediatrics, Duke University Medical Center, DUMC 102375, Hanes House Rm 370, Durham, NC 27710, USA.
Cystic biliary atresia (CBA) is a relatively uncommon but clinically significant variant of biliary atresia. The presence of a cyst in the hepatic hilum on imaging in an infant with cholestasis supports the diagnosis of CBA, but can also be seen in patients with a choledochal cyst-the main differential diagnosis in patients with CBA. The reported case outlines the clinical presentation and imaging findings in a patient with surgically confirmed and treated CBA and emphasizes the importance of distinguishing CBA from choledochal cyst at diagnostic imaging given the disparate timing and type of surgical treatment necessary for successful management of these distinct entities. Read More
BMJ Case Rep 2018 Jun 13;2018. Epub 2018 Jun 13.
General Surgery, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico.
Biliary cystic disease is a rare entity. Twenty-five per cent of cases are diagnosed during adulthood and only a few reports have described this condition during pregnancy, where it represents a therapeutic challenge for both obstetricians and surgeons with regard to the risks it entails for the patient and the fetus.Definitive management is surgical resection, as cysts may progress to malignancy if untreated. Read More
BMJ Open 2018 May 26;8(5):e022162. Epub 2018 May 26.
Department of Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, China.
Objective: The aim of this study was to evaluate factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation (CCM).
Design: A 3-year retrospective study was undertaken between January 2013 and December 2015 in four centres in China.
Setting: This involved a retrospective chart review of paediatric patients with CCM in four large hospitals in Southeast China. Read More
J Minim Access Surg 2018 May 24. Epub 2018 May 24.
Department of Surgery, Division of Pediatric Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India.
Introduction: Choledochal cyst (CDC) is often associated with intrahepatic stones (IHSs) in children which necessitate their removal during excision. The endoscopic equipment needed for their clearance such as paediatric flexible cholangioscope and other advanced modalities are not freely available in resource-poor setups. We describe per-operative modified rigid cholangioscopy using rigid paediatric cystoscope for stone removal during open CDC excision. Read More
ANZ J Surg 2018 May 22. Epub 2018 May 22.
Department of General Surgery, Taranaki District Health Board, New Plymouth, New Zealand.
BMC Pediatr 2018 05 11;18(1):158. Epub 2018 May 11.
Department of Pediatric Surgery, Nihon University, School of Medicine, 30-1 Ooyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Background: In biliary atresia, the disease process of obliterative cholangiopathy may begin in the perinatal period; however, no chronological evidence exists on how the cholangiopathy progresses to biliary obliteration. This is the first acquired case with the final diagnosis of type III cystic biliary atresia with an extrahepatic biliary cyst which showed the progression of obliterative cholangiopathy in chronological order after birth.
Case Presentation: An 81-day-old girl presented with acute abdominal distress due to bilious peritonitis caused by biliary cyst perforation, for which she underwent emergency biliary drainage. Read More
Cell Death Dis 2018 05 1;9(5):545. Epub 2018 May 1.
Department of Pediatric Surgery, Children's Hospital of Fudan University, and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China.
Biliary atresia is one of the most common liver disease in infancy. The cause and pathogenesis remain largely unknown. This study aimed to investigate the potential regulatory effect of miR-29b/142-5p on IFN-γ gene methylation. Read More
Surg Today 2018 Sep 20;48(9):835-840. Epub 2018 Apr 20.
Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Purpose: The late postoperative complications of choledochal cyst (CC) surgery are serious and include intrahepatic stones and biliary carcinoma; therefore, long-term follow-up is crucial.
Methods: The subjects of this retrospective study were patients who underwent surgery for CC at Kagoshima University Hospital between April, 1984 and December, 2016. We analyzed the operative results, early and late postoperative complications, and postoperative follow-up rate. Read More
BMJ Case Rep 2018 Apr 13;2018. Epub 2018 Apr 13.
Department of Obstetrics and Gynecology, Hamdard Institute of Medical Sciences and Research and HAHC Hospital, New Delhi, India.
Choledochal cyst is a rare congenital malformation which is usually found in young children and adolescents but can rarely present in the adult age group. It can present with several complications like cholangitis, pancreatitis, biliary cirrhosis, portal hypertension, liver abscess, malignancy and rarely spontaneous rupture (in 2% of cases) causing biliary peritonitis. A case of spontaneous rupture of choledochal cyst during second trimester of pregnancy is reported where the patient was managed by minimal surgery, peritoneal washout, placement of T-tube and planned for definitive treatment in the postpartum period. Read More
Ann Surg Treat Res 2018 Apr 26;94(4):190-195. Epub 2018 Mar 26.
Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Purpose: Increasing surgical expertise in minimally invasive surgery has allowed laparoscopic surgery to be performed in many abdominal surgeries. Laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy are challenging and sophisticated surgeries because of the difficult anastomosis. Recent advances in robotic surgery have enabled more delicate and precise movements, and Endowrist instruments allow for securing sutures during anastomosis. Read More
J Paediatr Child Health 2018 Jul 30;54(7):807-809. Epub 2018 Mar 30.
Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia.
Abdom Radiol (NY) 2018 Oct;43(10):2790-2808
Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Suite 1087, Main Building, Philadelphia, PA, 19107, USA.
Few things in radiology are "pathognomonic" in their appearance or presentation. However, having an awareness of those findings which are specific to a certain entity is important when interpreting imaging studies. These classic findings can be identified with many imaging modalities, but no modality provides as many recognizable observations as an MRI. Read More
Am Surg 2018 Feb;84(2):319-321
Am Surg 2018 Mar;84(3):462-465
Eur J Pediatr Surg 2018 Apr 6;28(2):156-162. Epub 2018 Mar 6.
Division of Pediatric Surgery, Hopitaux Universitaires de Geneve, Geneva, Switzerland.
Biliary atresia (BA) and congenital choledochal malformations (CCM) are rare. Both pathologies must (BA) or may (CCM) be operated during the neonatal period or early infancy. We briefly describe the classical operative techniques for both pathologies, followed by the most common and severe perioperative complications encountered during and up to 30 days after surgery in children operated for BA and CCM early in life. Read More
J Ayub Med Coll Abbottabad 2018 Jan-Mar;30(1):127-129
Department of Paediatrics, College of Medicine, King Saud University Medical City, Riyadh-Saudi Arabia.
Choledochal cyst is not an uncommonly seen entity in children. Presentation may be varied and at different age groups. Abnormal pancreaticobiliary junction is usually a phenomenon in acquired type of choledochal cyst. Read More
Acta Clin Croat 2017 Jun;56(2):344-348
Clinical Department of Internal Medicine, Sveti Duh University Hospital, Zagreb.
We report a case of biliary cyst type II which, independently of its a priori benign nature, caused numerous complications such as recurrent cholangitis and pancreatitis, as well as subsequent hepatic fibrosis and the potential danger of choledochocele perforation. Although they are benign, biliary/choledochal cysts can cause numerous disorders such as cholestasis, leading to cholangitis and pancreatitis and biliary sepsis, and due to chronic inflammation of the biliary system even cholangiocarcinogenesis. Our findings showed that sometimes this type of biliary cyst (according to the available literature the rarest and most benign type), as well as type I cyst, should undergo timely radical excision. Read More
Br J Surg 2018 04 26;105(5):482-490. Epub 2018 Feb 26.
Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
Background: Choledochal malformations comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. Choledochal malformation is generally considered a premalignant condition, but reliable data on the risk of malignancy and optimal surgical treatment are lacking. The objective of this systematic review was to assess the prevalence of malignancy in patients with choledochal malformation and to differentiate between subtypes. Read More
Gastroenterol Rep (Oxf) 2018 Feb 2;6(1):54-60. Epub 2017 Jul 2.
Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China.
Objective: To compare Roux-en-Y hepatico-jejunostomy with complete resection of the cyst or incomplete resection with 1-cm remnant proximal cyst wall in treating adult type I choledochal cyst (CC).
Methods: The medical records of 267 adult patients with type I CC from January 1998 to December 2015 were reviewed retrospectively. Among them, 171 underwent Roux-en-Y hepatico-jejunostomy with complete resection (PBD 0-cm group) and 96 underwent Roux-en-Y hepatico-jejunostomy with 1-cm proximal cyst wall left (PBD 1-cm group). Read More
J Pediatr Gastroenterol Nutr 2018 Aug;67(2):e36
Section of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine.
Medicine (Baltimore) 2018 Feb;97(8):e9956
First Hospital of Jilin University, Changchun, Jilin, China.
Rationale: Choledochal cysts are a risk factor for the development of cholangiocarcinoma. Hence, complete surgical excision is the preferred treatment in most cases. However, cholangiocarcinoma still can develop from the remnant biliary system after surgical excision. Read More
Sci Rep 2018 Feb 19;8(1):3309. Epub 2018 Feb 19.
Department of Biliary surgery, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, 200438, China.
Hepatocellular carcinoma with bile duct tumor thrombus (BDTT) is a malignant disease. The most commonly used diagnosis methods for BDTT are MRCP/ERCP, ultrasonic diagnosis or CT scan. However, BDTT is often misdiagnosed as other bile duct diseases, such as extrahepatic cholangiocarcinoma (EHCC), choledochal cyst (Cyst) and common bile duct stone (Stone). Read More
AJR Am J Roentgenol 2018 Apr 15;210(4):748-760. Epub 2018 Feb 15.
1 Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1611 NW 12th Ave, WW 279, Miami, FL 33136-1015.
Objective: The purpose of this article is to review the relevant pathophysiologic features, appearances, and surgical implications of choledochal malformations.
Conclusion: Choledochal malformations, colloquially called choledochal cysts, initially described in 1723, have been recategorized multiple times, the most widely accepted being the Todani classification based on morphologic features and location. Although readily applied to imaging findings, this classification system does not correlate well with clinical and surgical management. Read More
Prz Gastroenterol 2017 14;12(4):303-309. Epub 2017 Dec 14.
Clinic of Paediatry, University Hospital Motol, Prague, Czech Republic.
Introduction: Biliary cysts with an abnormal pancreatobiliary junction are one of the most common pancreatobiliary malformations. The main symptom is cholestasis; endoscopic retrograde cholangiopancreatography (ERCP) plays a key role in diagnosis.
Aim: Retrospective evaluation of ERCP performed to diagnose abnormalities of the pancreatobiliary junction. Read More