Jul 9, 2008

Choledochal cyst

Introduction: Choledochal cyst is congenital anomaly, where there is cystic dilatation of extrahepatic biliary duct, intrahepatic biliary duct or both.

Pathogenesis: Causative factors are

1.Congenital segmental weakness of the wall of biliary duct

2. Inflammatory degeneration of the wall of biliary duct (same as in biliary atresia)


Type I - Dilatation of entire or segment of common hepatic duct or coomon bile duct
a- Saccular
b- Fusiform
Type II - Diverticulum from common bile duct either sessile or pedunculated
Type III- Also called as choledochocele. Dilatation of intraduodenal portion of CBD
Type IV - Multiple cysts involving both intrahepatic & extrahepatic duct
Type V - Multiple cysts involving only intrahepatic ducts

Clinical presentation:
1. Abdominal pain
2. Mass in upper abdomen
3. Jaundice

1. Liver function tests
2. Ultrasonography of abdomen
3. Magnetic resonance cholangiopancreatography
4. Intraoperative cholangiogram

1. Excision of cyst & Roux-en-Y choledochojejunostomy
2. Excision of mucosa & anastomosis between side of the cyst & the jejunum