Management
Choledochal cysts
A choledochal cyst is a congenital anomaly of the duct (tube) that transports bile from the liver to the gall bladder and small intestine. Choledochal cysts are rare, with an incidence of 1:100,000-150,000.
Choledochal cysts are usually diagnosed in childhood, although in utero and adult diagnosis is also common. Common presentations include abdominal pain, jaundice, and right upper quadrant mass and are most commonly seen in pediatric patients.
Types and locations of choledochal cysts
- Type 1 — a cyst of the extrahepatic bile duct, accounting for up to 90% of all choledochal cysts.
- Type 2 — an abnormal pouch or sac opening from the duct.
- Type 3 — a cyst inside the wall of the duodenum.
- Type 4 — cysts on both the intrahepatic and extrahepatic bile ducts.
Abdominal ultrasonography is the test of choice for the diagnosis of a choledochal cyst. Ultrasonography is useful in the antenatal period as well and can demonstrate a choledochal cyst in a fetus as early as the beginning of the second trimester.
Computed tomography (CT) is infrequently required in the situation where the distal common bile duct is not visualized due to bowel gas Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the diagnostic methods of choice for biliary ductal pathology.
The treatment for a choledochal cyst is surgery. The purpose is to remove the cyst and create good bile flow from the liver to the small intestine. For children with type I cysts, the surgery is called Roux-en-Y hepaticojejunostomy.
