Choledochal cysts
From Ask Dr Wiki
Choledochal cysts are congenital conditions associated with benign cystic dilatation of bile ducts. They are uncommon in western countries[1] but not as rare in East Asian nations like Japan and China.
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Presentation
Most of them present in 1st year of life; adult presentation is rare and usually at this stage is associated with complication . Classic triad of intermittent abdominal pain, jaundice, and a right upper quadrant abdominal mass is found only in minority of patients.
Types
They were classified into 5 types by Todani in 1977[2].
Classification was based on site of the cyst or dilatation. Type I to IV has been subtyped.
- Type I: Most common variety involving sacular or fusiform dilatation of a portion or entire common bile duct (CBD) with normal intrahepatic duct.
- Type II: Isolated diverticulum protruding from the CBD.
- Type III or Choledochocele: Arise from dilatation of duodenal portion of CBD or where pancreatic duct meets.
- Type IV: Dilatation of both intrahepatic and extrahepatic biliary duct.
- Type V or Caroli's disease: Cystic dilatation of intra hepatic biliary ducts.
Treatments
Choledochal cysts are treated by surgical excision of the cyst with the formation of a roux-en-Y anastamosis to the biliary duct. Future complications include cholangitis and a 2% risk of malignancy, which may develop in any part of the biliary tree.
