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)

Types:

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

Diagnosis:

1. Liver function tests

2. Ultrasonography of abdomen

3. Magnetic resonance cholangiopancreatography

4. Intraoperative cholangiogram

Treatment:

1. Excision of cyst & Roux-en-Y choledochojejunostomy

2. Excision of mucosa & anastomosis between side of the cyst & the jejunum