Choledochal Cyst

Choledochal cyst
• Cystic dilatations of the extrahepatic
biliary tree
• Intrahepatic biliary ducts
 Choledochal Cyst
• Females > Males
– Affects females three to eight times
than males

• Unknown cause
– weakness of the bile duct wall and
increased pressure secondary to partial
biliary obstruction are required for
biliary cyst formation
 Choledochal Cyst
• More than 90% of patients have an
anomalous pancreaticobiliary
duct junction
– with the pancreatic duct joining the
common bile duct >1 cm proximal to
the ampulla
Clinical Manifestations
 Clinical Manifestations
• Clinical triad
– abdominal pain
– jaundice
– palpable abdominal mass
 Clinical Manifestations
NEWBORNS OLDER CHILDREN
• usually diagnosed • abdominal pain
within the 1st present
month • jaundice
• jaundice • occasionally
• passage of acholic palpate a soft
stools mass in RUQ
• often have • can develop
palpable mass in cholangitis,
RUQ eventually leading
• pain not present to cirrhosis &
portal
hypertension
Ancillary Procedures
 Ancillary Procedures
• Fetus
– screening prenatal ultrasound

• Older child or adolescent

– abdominal ultrasonography may reveal
a cystic structure arising from the biliary
tree

• CT scan will confirm the

diagnosis
Abdominal Ultrasonography
• Screening procedure of choice
• Class of the cyst can be identified
• But preoperatively- confirmed by CT
or MRCP\
• Cystic extrahepatic mass
Abdominal Ultrasonography

Choledochal cyst: surgical perspective.

Sonogram shows a large unilocular cyst
under the liver. (emedicine. Besner GE )
 CT Scan
• Highly accurate in diagnosing and
planning surgery
• Dilated cystic mass with clearly defined
walls which is separate from the
gallbladder
• mass arises from or actually is the
extrahepatic bile duct usually is clear
from its location and its relationships to
surrounding structures ,
• the wall of the cyst can appear
thickened, especially if multiple
episodes of inflammation and
 CT Scan
• Large Type I choledochal cyst &
adjacent gallbladder
 ERCP
• reserved for patients in whom
confusion remains after evaluation
by less-invasive imaging modalities

Choledochal cyst and associated

biliary anatomy
 MRCP
• more detailed depiction of the
anatomy of the cyst, and its
relationship to the bifurcation of the
hepatic ducts and the pancreas

Choledochal cyst: surgical

perspective. Magnetic resonance
cholangiopancreatography shows
dilated hepatic ducts and common
bile duct (CBD) of a type IV cyst.
(emedicine. Besner GE )
 Blood test
Non-specific
• status of the patient
• possible complications
• ↑ serum bilirubin
• ↓ blood clotting (severe cholangitis /
longstanding biliary blockage)
Types of Choledochal
Cysts
 Types
• Type I choledochal
cysts

– dilatations of the
entire common
hepatic and
common bile ducts
or of segments of
each
– saccular or fusiform
in configuration
 Types
• Type II choledochal
cysts

– isolated protrusions
or diverticula that
project from the
common bile duct
wall
– sessile or
connected to the
common bile duct
by a narrow stalk
 Types
• Type III
choledochal cysts

– choledochoceles
– found in the
intraduodenal
portion of the
common bile duct
 Types
• Type IVA cysts

– multiple dilatations
of the intrahepatic
and extrahepatic
biliary tree
– large, solitary cyst
of the extrahepatic
duct is
accompanied by
multiple cysts of
the intrahepatic
ducts
 Types
• Type IVB
choledochal cysts

– multiple dilatations
that involve only
the extrahepatic
bile duct
 Types
• Type V choledochal
cysts
– dilatation of the
intrahepatic biliary
ducts
– numerous cysts are
present with interposed
strictures that
predispose the patient
to intrahepatic stone
formation, obstruction,
and cholangitis
– found in both hepatic